11/20 Health Disparities Flashcards
______ defines disability as an umbrella term for impairments of body functions and structure, activity limitations, and participation restrictions.
World Health Organization
ICF model provides what view of disability vs. medical model.
Broader view beyond diagnosis: activity, body function, participation, personal factors, social roles, self-care, environment barriers, motor, cognition, and affective.
Medical model just health and body and function: motor and cognitive and affect.
The international classification of functioning disability and health (ICF) framework:
____ is distinct from disability and
________ is an interaction between feature of a person and features of the society in which a person lives
Health is distinct from disability and
Functioning/disability is an interaction between features of a person and features of the society in which the person lives
___% adults in US has a disability
26%
Most serious difficulty walking stairs, then issues concentrating.
Adults ID not well captured in cognitive questions
Are adults with IDD well represented in US health data?
No they are invisible
Health Inequalities
Systematic, socially produced, and important differences in health between groups that are unnecessary and unjust.
Groups based on identity or other characteristic historically linked to discrimination or exclusion
Examples of Racial and Ethnic Disparities
Infant mortality, life expectancy, prevalence of chronic disease, and insurance coverage
Disparities remain regardless of income, health insurance, and access to care
Disparities constant over time between Black and White and growing between White and Hispanic groups.
Compared to people without disabilities, people with IDD have…
Poorer overall health
More health risks
More specialized health care needs
National Surveillance:
Lack of IDD health data and wanted to do something
What sources did it use?
What populations did it compare?
Sources: 1) Behavior risk factor surveillance survey (BRFSS) 2) National Core Indicators (NCI)
Populations: no disability, disability, IDD
Behavior Risk Factor Surveillance System (BRFSS)
Random dial telephone survey (Health-related risk behaviors, Chronic health conditions Use of preventative services)
In 2010, two questions screened for disability (did not have 6 questions, that came later).
(1) ‘‘Are you limited in any way in any activities because of physical, mental, or emotional problems?’’
(2) ‘‘Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?’
National Core Indicators
What were the 3 sources of information?
Quality Management protocol for DD service delivery system
Coordinated nationally by Human Services Research Institute with 25 state participating in 2009-2010
Standard instrument, interviewer training, and methodology (random sample of adult)
Three source of information: self-report, proxy (informant), and service coordinator (file).
Issue with NCI data?
85% should be mild, but breakdown was more even, 35.7% mild. Oversampling of moderate to profound groups.
Developmental disability vs. disability in general
Developmental disability: more likely to not exercise and have inadequate emotional support than general disability or no disability
Disability in general: more likely to smoke or have large BMI
Common Health Risks Among Adults with IDD:
Sedentary
H-pylori bacterial infection
Obesity
Constipation
Poor nutrition Gastroesophageal reflux (GERD)
Inadequate emotional support
Social Determinants of Health
Examples
Conditions in places where people live, learn, work, and play impact health risks and outcomes
Economic stability
Neighborhood and built environment
Education access and quality
Social and community context
Healthcare access and quality
Administrative Health Data Preconception Health:
15-44yo with physical, sensory, and IDD
* IDD (n = 8,986) included ASD and ID
– social determinants of health
– physical health status
– psychosocial well-being
– history of assault
– teratogenic medication use
Compared to women without disability…
with disability: worse SES, mood/anxiety, asthma, stable/unstable chronic med conditions, diabetes, teratogenic meds
Highest in DD: most disadvantaged, mood/anxiety, psychotic disorders, other mental illness, self-harm, substance use, teratogenic meds, history of assault.
Intersectionality
People from marginalized identity groups who also have disabilities confront an enormous health disparity amplifying phenomenon.
Women’s Health at the intersection of disability, race, and ethnicity
2016 Behavioral Risk Factor Surveillance System (BRFSS), data from 50 states, district of Columbia, and 3 territories
N=59,317 women ages 18-44 years
37,942 (64.0%) White women, non-Hispanic
6,662 (11.2%) Black women, non-Hispanic 9,162 (15.5%) Hispanic women (of any race), and
5,551 (9.4%) women from other races and ethnicities (e.g.,
Asian, American Indian, Pacific Islander, multi-racial)
What were the 6 questions?
In disability group if you said “yes” to any of these:
1. Are you deaf or do you have serious difficulty hearing?
2. Are you blind or do you have serious difficulty seeing, even when wearing glasses?
3. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?
4. Do you have serious difficulty walking or climbing stairs?
5. Do you have difficulty dressing or bathing?
6. Because of a physical, mental, or emotional condition, do you
have difficulty doing errands alone such as visiting a doctor’s
office or shopping
2016 Behavioral Risk Factor Surveillance System (BRFSS):
In each racial and ethnic group, women with disabilities had and reported…
sig. less education,
less likely to be married, and less likely to be employed
over-represented in the lowest income categories and under-represented in the highest income categories
fair/poor health, no dental visit past year, smoking/binge drinking, obesity, lack of exercise, mental distress, diabetes, current asthma
National Vital Statistics System 2005–2017 US Multiple Cause
of Death Mortality files, age 18+
Compared ID (n=22,512) to not-ID (n=32,738,229)
Landes et al. (2021) revised the underlying cause of death for the ____% of death certificates that had an ID erroneously reported as their underlying cause of death
23.9%
Non-ID: 74 years
All ID: 61.1 years
Mild/mod: 63.6 years
Severe/profound: 57.2 years
Adults with ID…
___X more likely to die from choking
___X more likely to die from pneumonitis
___X more likely to die from influenza and pneumonia
___X more likely to die from unspecified causes.
Choking, pneumonitis, influenza and pneumonia, unspecified causes
26.3x
20.8x
5.9x
4x
Women live significantly longer than men in US (7 years) BUT why not in ID?
Maybe protected against factors that hurt men more? Hard to say…
74, 70.9 (Male), 77.4 (Female)
ID:
61.1, 60.1 (Male), 62.3 (Female)
Are mortality disparities across race/ethnicity in US similar in ID as not ID groups?
Yes
ID white: 62.7
Black: 55.5
Hispanic: 52.8
Other: 53.8
Leading cause of death not ID vs. Mild/mod vs. severe/profound
1 cause in everyone is heart disease
2 cause in not ID and mild/mod is malignant neoplasm. Respiratory causes in severe/profound.
3 Not ID: Dementia/Alzheimers
Mild/Mod: Diabetes mellitus
Severe/profound: Pneumonitis and influenza pneumonia
National Survey on Health and Disability, internet-based
survey (n=1246)
* 54 Autistic adults, 35% were LGBTQ
* Compared 19 LGBTQ respondents to 35 straight, cisgender
LGBTQ respondents reported worse health and more barriers to health care, despite having insurance
2X more likely to have psychiatric disorder
2X as many poor physical health days per month,
10X more likely to smoke
significantly higher rates of unmet health care needs, problems with insurance provider network,
35.7% reported being refused services by medical provider (compared to 20% straight, cisgender with ASD)
True or false: People with IDD may be the most medically underserved population
True
Similar or higher risk of chronic health conditions: diabetes, heart disease, respiratory conditions. More likely to have health insurance on medicaid. Usually reserved for those who are poor unless you have ID, blind, certain conditions. Then you can just be poor. You don’t need to be super poor.
Low rates of primary health care visits despite insurance
Lack of preventive care
Low rates of specialty care
Untreated medical conditions
Barriers to health care for people with DD
Big issue
Big issue: People are more likely to treat disorders aggressively (cancer) when they view your life as having quality
Adults with IDD have a particularly difficult time finding healthcare providers
Providers do not take the time to listen or respect them
Healthcare providers report they are unprepared and uncomfortable caring for patients with disabilities
Barriers to Adequate health in community:
Availability- Does it exist?
shortage of health-care professional willing to accept patients with disabilities, especially specialists (dental care, OBGYN, mental health)
Transportation problems getting to appointments (distance and expense)
Barriers to Adequate health in community:
is it accessible?
Physical/architectural barriers
Communication barriers
Attitudinal barriers
Social/economic policy barriers
Health service Inflexibility may pose barrier
Barriers to Adequate health in community:
Appropriateness- Does it meet the needs of the patient?
Health-care professionals receive inadequate training in disability
Sexual/reproductive health neglected
Insufficient appointment time
Barriers to Adequate health in community:
Affordability- is it financially within reach?
Low reimbursement rates (medicaid/medicare)
Some healthcare costs are not paid by insurance companies, especially transportation
DD: Less likely to have _____screenings Why?
Cancer screenings.
Less likely to either get referred out or have specialists in that area.
Disability competence is lacking.
What do those with disabilities say?
What do healthcare providers say?
People w/disabilities report difficulty finding able and willing healthcare providers and that providers do not respect or listen
Healthcare providers report they are unprepared and uncomfortable caring for patients with disabilities.
______ is the answer to healthcare disparities.
But what are the limits of these programs?
Education
Don’t reach all students. Rely on champions and funding
Examples of education training programs that work
LEND provide disability training for
interdisciplinary health students
● Funded by MCH
National Disability Curriculum
Initiative on Developmental Medicine
creates intellectual disability content
for use at medical schools
● Supported by CDC, AADMD and Special Olympics
Why should we invest in disability training?
Prepare future health care professionals
Address health inequities
Meet the needs of underserved populations, including people with disabilities
Disability competence milestones. (6 of them)
- Decide what health care providers need to understand about disability.
a. Barriers to healthcare
b. How to accommodate disabilities and where to get resources - Require disability training for accreditation and licensure
- Develop robust protocols to evaluate
- Develop evidence-based curricula
- Evaluate the impact of disability training on health care delivery and on health outcomes.
- Health care delivery models/incentive structures to promote disability-competent care
National Consensus on 6 Disability Competencies: who did that
Disability stakeholders contributed to a Delphi process coming to consensus on 6 disability competencies essential to providing quality health care to patients with disabilities
Health equity framework for people with disabilities: National Council on Disability 2022 Policy Brief
Provides rationale for an all-of-government approach to achieve health equity in the United States and our territories for the largest unrecognized minority group in this country, the over 61 million people with disabilities, and sets forth a framework to achieve health equity for all people with disabilities
Calls for 4 Changes
- Designating people with disabilities as a Special Medically Underserved Population (SMUP) under the Public Health Services Act;
- Requiring comprehensive disability clinical-care curricula in all US medical, nursing and other healthcare professional schools;
- Requiring the use of accessible medical and diagnostic equipment;
a. Old laws said accessible for federal funds, but didn’t add in the medical equipment for hospitals - Improving data collection concerning healthcare for people with disabilities across the lifespan
What disability Content can be Easily Integrated into Existing Curricula?
Didactic- Lectures, advanced competency electives, online training resources
Case-based or problem-focused activities
Patient panels- people with disabilities, family members, caregivers
Health education projects at disability-related community sites
Clinical encounters with people with disabilities
_______ is the process of enabling people to increase control over and to improve their health.
What specifically does it promote?
health promotion
promotes: social and active recreation, health literacy and self-management of their chronic disease.
Issues in health of adults with DD
Less regular physical activity. Poor health literacy, poor diet choices.
Physical activity reduces risk of…
Epilepsy
Diabetes
Osteoporosis
Cardiovascular disease
Sensory impairments
Mental health issues
Cancer
Constipation
GERD
Group Fitness Program
Health Promotion program for adults with IDD
Addresses health literacy, physical activity, nutrition
Learn and practice practical aspects of exercise
12 week program with 3 1-hour sessions per week (total of 37 lessons)
Improve self-advocacy skills and self-esteem
Health Matters Impact
Increase in knowledge and confidence to make healthy food choices
More physically active
Increase in number of health behaviors
What participants do to stay healthy
What they eat/don’t eat to be healthy
how much they exercise
HealthMatters @ university of Kentucky HDI
Make friends like them
