Exam 1 - health disparities

Question 1

biomedical model

Answer 1

health is define by absence of illness and disease is caused by damages to cells due to pathoanatomical changes

Question 2

psychological model

Answer 2

individuals provide their own assessment of their health

general feeling of well being

Meps - medical expenditure panel survey (5 categories)

Question 3

sociocultural model

Answer 3

health may be defined as the state of optimum capacity of an individual for the performance of roles and task - normal lvl of functioning - feeding, bathing, dressing

Question 4

Several behavioral factors exert a strong
influence on health.

Answer 4

Typical ‘behaviors’= misbehaving
* Lack of exercise
* Poor diet
* Smoking
* Drug/Alcohol Abuse
* Unsafe sexual practices, etc.
13

Question 5

ecological model

Answer 5

Health is affected by the interaction
between the individual, the
group/community, and the physical,
social, political, and other environments.
* Helps develop effective multi-level
approaches to improve health behaviors.

public policy
community
organizational
interpersonal
individual

Question 6

holistic concept of health

Answer 6

all sectors of society have an effect on health

Question 7

health as a multidimensional concept

Answer 7

each dimension is continuous and may be casually lined

social
psychological
physical
environmental

Question 8

health disparity

Answer 8

inequality in health status or outcome related to some kind of injustice, oppression, or difference in sociodemographic status

Question 9

health disparity

Answer 9

contrast between what constitutes a simple inequality and a disparity

simple inequality - difference between groups that may and may not be related to social injustice

health disparity - involves the link to some kind of injustice

CDC—“differences in health outcomes between groups
that reflect social inequalities”
* APHA—“differences in health status between people
that are related to social or demographic factors such
as race, gender, income, or geographic region

Healthy People 2010—“differences that occur by
gender, race or ethnicity, education or income,
disability, living in rural localities, or sexual orientation”
* Healthy People 2020—“a particular type of health
difference that is closely linked with economic, social,
or environmental disadvantage and characteristics
historically linked to discrimination or exclusion

Question 10

health equity

Answer 10

Ensuring an equal opportunity to a healthy
outcome and an equal access to live a
healthy life.

Achieved by eliminating health disparities and
addressing social determinants of health
(SDoH).
* Focuses on solutions to eliminate differences and
improve outcomes.
* Developing solutions requires incorporating
social justice.

Question 11

social justice

Answer 11

Ensuring everyone has equal rights and
opportunities which include the right to good
health and healthy outcomes.
* The inequities and disparities that occur between
sociodemographic groups are connected to a
history of social injustice.
* Addressing societal injustices (e.g., racism,
discrimination, etc.) is essential to achieving health
equity.

The pathway to health equity is reliant on
social justice.

Question 12

Dr. J. Marion Sims

Answer 12

Experimented on slave women without anesthesia to
increase their ability to work in the fields and have
more children (i.e., increase the owner’s slave
population).
* While his achievements in gynecology have been hailed,
his methods shine a light on the medical profession’s
dark and painful past.

Question 13

Tuskegee Syphilis Study

Answer 13

Precursor agency to the CDC
conducted unconsented research on
African American men and withheld
effective treatment for decades.
* Most cited as a source of modern
mistrust of the medical community

Question 14

American Eugenics

Answer 14

Deeply rooted history of sterilizing many
minority patients against their will and
often without their knowledge.
* Sheds light on failure of healthcare system in
recognizing the fundamental humanity and
autonomy of marginalized groups.

Question 15

Dr. John Ruffin

Answer 15

Renowned biologist who became NIH’s first Associate
Director for Minority programs in 1990, advancing the
group to eventually become the National Institute on
Minority Health and Health Disparities.
* Worked to institutionalize the importance of health
disparities in the federal government.
* Impact of his work laid the foundation for federal
minority health and health disparities research.

Question 16

Healthy People Initiative: Federal plan for
addressing health disparities

Answer 16

First launched in 1990 as Healthy People 2000.
* U.S. Department of Health and Human Services’ roadmap for
improving the health of Americans by the turn of the century.
* Helped to shape HHS policies and funding decisions for a decade.
* Revised and updated every decade with the aim of achieving set
goals.
* Healthy People 2010 was updated in the year 2000 and Healthy
People 2020 in the year 2010.
* Research in health disparities has laid a solutions-driven pathway to
achieving health equity.
Historical Context of Health Disparities

Question 17

remember

Answer 17

➢ Equality
Ensuring equal
access to certain
resources
➢ Equity
Ensuring equal
outcomes for all
➢ Justice
Removing the
barriers that
lead to inequity

Question 18

health disparity

Answer 18

Health difference that adversely affects disadvantaged populations,
based on one or more of the following health outcomes:
2
▪ Higher incidence and/or prevalence & earlier onset of disease.
▪ Higher prevalence of risk factors, unhealthy behaviors, or clinical
measures in the causal pathway of disease outcomes.
▪ Higher rates of condition-specific symptoms, reduced global daily
functioning, or self-reported health-related QoL using standardized
measure.
▪ Premature and/or excessive mortality from diseases where population
rates differ.
▪ Greater global burden of disease using a standardized metric

Question 19

incidence

Answer 19

The number of new cases of a condition that develop
in a population over a specific time period (such as a month or
year). Incidence can be reported as a rate or risk

Question 20

prevalence

Answer 20

The proportion of a population that has a condition at a specific time period, regardless of when they first developed it. prevalence takes into account the duration of the condition

Question 21

rate

Answer 21

Measure of the frequency with which an event occurs in a
defined population over a specified period of time.
E.g., Incidence rate, Mortality rate
3

Question 22

Racism

Answer 22

Racism is a system of beliefs and structures that denigrate
and disadvantage members of racial groups who are
categorized and regarded as inferior.

It is essential to understand that racism is multidimensional
and systemic.

The major components or levels of racism can
be visualized as intersecting circles rather than
discrete classifications.

Question 23

Three levels of racism

Answer 23

• Intrapersonal racism: the ideology
  of racism internalized in people’s
  thoughts. Consists of prejudice and internalized racism.
• Interpersonal racism: discriminatory actions or
  behaviors between individuals or across institutions.
  Consists of institutional racism.
• Structural racism: discriminatory actions in the social
  systems based on race.

Question 24

There are four key concepts that illustrate
racism

Answer 24

Racial Prejudice
❑ Discrimination
❑ Structural racism
❑ Internalized racism

Question 25

racial prejudice

Answer 25

Negative beliefs, attitudes, or assumptions held about
individuals or groups based on their race

Rooted in ideology and reflects the collective biases and
misunderstandings that are perpetuated in societies.
▪ Involves stigma which can be a major source of stress for
individuals in racially stigmatized groups and has negative
consequences

Prejudice can occur based on race, sex, disability,
and other stigmatized social statuses

Question 26

Discrimination

Answer 26

Actions or behaviors that unfairly target individuals based
on their race.
▪ Also defined as “differential treatment on the basis of race that
disadvantages a racial group” (National Research Council, 2004)
▪ Applies to differential treatment based on sex, sexual orientation,
gender identity, and other factors.
Negatively impacts health
▪ Does not have to be personally recognized nor intentional to have an
impact.
▪ Institutionalized forms (e.g., housing discrimination or unequal
treatment in healthcare ) also have impacts.

Question 27

Structural
Racism

Answer 27

A social system rooted in racial ideologies that
maintains unequal distribution of and access to power
and societal resources.
▪ Viewed as a fundamental cause of health inequities
among racial groups.

Exemplified by historical traumas that have intergenerational
effects on health.
o African American enslavement
o Colonization of Native Americans
o Internment of Japanese Americans during WWII
o Marginalization and criminalization of undocumented immigrants

▪ Can manifest in various ways:
* Racial residential segregation
* Environmental injustice
* Political disenfranchisement
* Mass incarceration
* Immigration policies

Question 28

Institutional
Racism

Answer 28

Discriminatory policies and practices within institutions
such as healthcare, education, and housing.
▪ Often described interchangeably with structural
racism which deals with how stratified social systems
result in differential opportunities and distributions of
societal resources by race

Question 29

Internalized racism

Answer 29

When members of stigmatized
races accept negative stereotypes that have been
perpetuated about their individual or group
abilities and self-worth.
▪ Negatively impacts persons who internalize
stereotypes of racial inferiority.
o Negative self-concepts
o Depression
o Psychological distress 14

Question 30

Cultural Racism

Answer 30

a cultural system that propagates false
notions of superior culture.
▪ Results in unconscious bias

Question 31

Implicit bias

Answer 31

internalized perceptions about group inferiority
that are subconsciously acted upon.
▪ Can have detrimental effects on stigmatized groups, particularly in healthcare
o Poor patient-provider communication
o Biased treatment recommendations
▪ Related to aversive racism: subtle biases in social interactions and decision-
making
o Observed among even well-intentioned individuals
o Contributes to disparities

Question 32

race

Answer 32

Race is a social construct.
▪ Groups are categorized based on ideologies of
superiority and inferiority that are relative to phenotype,
group affiliation, and socially ascribed characteristics.
▪ Race is not “real” in the biogenetic sense.
o No genes exclusively or consistently map onto “Black” or
“White” races.
o The complex system of racism exemplifies the
materialization of this fictitious notion.

Question 33

racism

Answer 33

▪ Racism is a fundamental cause of health disparities.
▪ It operates through multiple pathways:
o Stress
o Racial residential segregation
o Immigration policy
o Healthcare access
▪ Associated with poor mental and physical health
among racial/ethnic groups

Question 34

african americans

Answer 34

Diabetes, hypertension, and cardiovascular disease(CVD)
disproportionately affect African Americans.
▪ Other conditions: Kidney disease, cancer.
▪ Mental health disorders and obesity associated with self-
reported racism.
▪ Smoking and alcohol use linked with perceived racial
discrimination.
▪ Most studies of racism and health have examined African
American populations.

Question 35

Latinos/Latinas (or gender neutral-Latinx

Answer 35

Usually categorized as “White”.
▪ Often marginalized as “foreign” regardless of nativity or immigration
status.
▪ High prevalence of perceived racial/ethnic discrimination based on
race, ethnicity, and language.
▪ Negative impact on health as a result:
o High blood pressure
o Increasing BMI
o Smoking
▪ Common conditions- Diabetes, CVD, Cancer,
Asthma, Obesity, Mental health disorders. 19

Question 36

Asian Americans

Answer 36

Positive association between perceived discrimination and a
number of chronic health conditions.
o Cardiovascular disease
o Respiratory disease
o Cancer
o Chronic Pain
▪ Mental disorder 3× more likely among those that report
experiences with discrimination.
o Depression
o Anxiety

Question 37

arab americans

Answer 37

increased risk of experiencing racial hostility.
▪ Also formally classified as “White”.
▪ Perceived religious or ethnic discrimination associated
with higher levels of psychological distress and poor
health status.
o e.g., Increased low birth rate and preterm birth reported among some
women with Arab surnames 6-months after 9/11.
o Physical and psychological trauma due to hate crimes.
o Cardiovascular disease, Respiratory disease, Mental health disorders.

Question 38

native americans

Answer 38

History of experienced racial inequities.
▪ Social disadvantage and psychological trauma have
influenced health outcomes and behaviors.
o Alcohol and drug use
o Smoking
o Cardiovascular disease (especially high blood pressure)
o Diabetes and other chronic diseases

Question 39

stress

Answer 39

Stress is a major mechanism through which racism
harms health.
▪ Racism is a chronic stressor and can cause biological dysfunction
and health deterioration over a lifetime (allostatic load).
o Dysfunction of stress pathways in the body- HPA axis
o Increase in cellular aging and chronic disease risk
▪ Stress-induced unhealthy behaviors are potential
pathways to racism through which racism can
influence health outcomes.
▪ Internalized racism linked with poor health outcomes.
▪ Racism is not merely a life event, but a total lived experience.

Question 40

residential segregation

Answer 40

Racial residential segregation
refers to the relative concentration
and geographic separation of
racial groups in residential areas.
▪ Influences the built environment (supermarkets, parks,
safety, etc.)
▪ Food desserts, Food swamps
▪ Dictates the quality of schools and employment
opportunities.
▪ Increased exposure to environmental toxins and lack
structural supports for health-promoting activities

Question 41

immigration policy

Answer 41

Immigration policy can be conceptualized
as structural racism to the extent that it negatively
targets and disadvantages racialized groups.
▪ The marginalization and exclusion of immigrant groups as
a result of immigration policy constricts opportunities for
immigrant groups, in turn creating health inequities.
▪ restricted access to safety nets such as Medicaid, housing and
education subsidies, and other public support programs.

Question 42

healthcare

Answer 42

Differences in the access to, and
quality of, care for racial and ethnic
minorities that are associated with poorer health
outcomes.
▪ Implicit bias and perceived racism are associated
with:
▪ less patient-centered communication
▪ patient mistrust of the healthcare system
▪ delayed entry into care
▪ lower adherence to prescribed treatment

Question 43

Strategies to Address Racism and Health

Answer 43

Socio-ecological Approach -
Socio-Ecological Model
(SEM) recognizes the need
for engagement at all
levels.
▪ This model provided a
broad platform for
addressing social
determinants of health
associated with racial
disparities.

Intersectional approach
▪ REACH program
Racial and Ethnic Approaches to Community Health
(REACH)
▪ Comprised of public health, community, academic, and other
institutional partners, developed and implemented
interventions with a focus on “undoing” racism at the
individual, institutional, and systems levels.
▪ REACH adopted principles of the People’s Institute for
Survival and Beyond (PISAB)
▪ To undo Racism: understand what it is, where it comes from,
how it functions, and why it is perpetuated

Community-based/Community-engaged
research
▪ CBPA/CE principles
Community-based participatory approaches (CBPA) fall
on the spectrum of CE (Community Engagement) and
necessitate CE throughout the process.
▪ Engaging community-based organizations, faith-based
organizations, and other institutions within the community in
creating culturally specific interventions.
▪ Garner community buy-in and provide education through
Community Outreach events.

Question 44

Introduction
to Health
Equity
Frameworks
and Theories

Answer 44

The frameworks, models, and theories
that have been developed are integral to
understanding the field of health equity.
▪ The major concepts that will be discussed are
the following:
❑ Social Determinants of Health
❑ Intersectionality Theory
❑ Minority Stress Theory
❑ Maslow’s Hierarchy of Needs
❑ Social Ecological Model
▪ These models do not compete with each
other, nonetheless, they each help to explain
a different dimension of health equity.

Question 44

Social
Determinants
of Health

Answer 44

The conditions in which people are born,
grow, live, work, and age” (WHO, 2019).
▪ Helps with understanding the ways in which a
person’s context and lived experiences shape
their health and influence their health decisions
and actions.
▪ A major component regarding the origins of
health disparities lies in the sociocultural
context individuals find themselves.
▪ The term was not used in the health equity
field until the 1990s and took decades for it to
come to the forefront of research

Question 45

healthy people 2020 - social determinants

Answer 45

Developed by Healthy People 2020 and
consists of five key areas:
❑ Economic Stability
❑ Education
❑ Social and Community Context
❑ Health and Healthcare
❑ Neighborhood and Built Environment
▪ Healthy People 2020 also identified key
underlying issues that make up each category.
▪ The SDOH framework provides the means to
analyze the impact of factors such as
discrimination and the role in which they play in
health disparities.

Avoid the temptation to conclude that
variations in the socioeconomic aspects of
the social determinants of health are the
entire source of disparities.
▪ For example: Differences in education
attainment among racial/ethnic groups do not
explain differences in employment rates

The role that social determinants play in health
disparities and health equity should not be
overlooked or oversimplified.

Question 46

intersectionality

Answer 46

Term traces its roots to 1989 article by Kimberlé Crenshaw :
“Demarginalizing the Intersection of Race and Sex: A Black
Feminist Critique of Antidiscrimination Doctrine, Feminist
Theory, and Antiracist Policies”.
➢ Used in the context of the lived experiences of African
American women in terms of oppressions associated with
their gender and their race.
➢ Crenshaw argues that in order to truly understand injustice,
one cannot ignore the presence of either identity.
➢ Article led to looking at not only gender and race but all
dimensions of an individual’s identity (sexual orientation,
gender identity, geographic origin, etc.) when addressing
health disparities and inequities

Focuses on how the multiple identities
within an individual combine in ways that can
have a profound impact on health.
▪ One of the most important guiding principles in the
field of health equity because of its ability to
incorporate an individual’s multiple identities in a
way traditional disparities work did not.
▪ Solutions that examine the overlap of these
identities have the greatest chance at success,
scalability, and acceptability.
➢ Intersectionality is critical when discussing
groups impacted by health disparities
because everyone is made of multiple
identities.

Question 47

minority stress theory

Answer 47

Initially developed to describe how the oppressive
experiences of LGBTQ+ individuals contribute to
increased levels of engagement in health-risk behaviors.
➢ Critical in understanding LGBTQ+ health because it
helped refocus intervention targets away from LGBTQ+
individuals and more on the social reasons for the risky
behaviors.
➢ Also used as a model for minority oppression in other
groups (racial/ethnic minorities) due to its flexibility to
multiple identities, and its focus on the process through
which individuals experience oppression

Minority stress is a created, nonessential stress that
presents a unique opportunity for intervention and a larger
social justice focus.
➢ Stressors experienced by LGBTQ+ individuals (and by
extension, other minority groups) have three aspects that
uniquely drive health risks:
❑ These stressors are unique.
o Minority stress focuses on experiences that are specific
to the minority group.
▪ Prejudice
▪ Microaggressions
▪ Identity rejection
▪ Internalized homophobia
▪ Hate-based victimization
❑ Minority stress is chronic because it is integrated into the
very fabric of society.
❑ Minority stress is derived from social origins

Question 48

marslow’s hierarchy of needs

Answer 48

Holds that degree of motivation for a
certain behavior is driven by the level of
needs that person has already met.
▪ Can be used to understand the ways in which
people make decisions about their health-
related behaviors.
➢There are five levels of needs
❑ Physiological
❑ Safety
❑ Love and belonging
❑ Esteem
❑ Self-actualization
▪ Until a more basic level of needs is met, an
individual will not be motivated to engage in
activities related to a higher level of need.

Relevance to health equity is in its ability
to explain how sociocultural disadvantage
prevents individuals from pursuing certain
health-related behaviors and from
achieving their full potential in society.
➢Also overlaps with the SDOH framework
because it explains why the continued
threat of losing access to basic needs has
such a systemic impact on an individual.

Question 49

social ecological model

Answer 49

Focuses on the ways in which an
individual’s own beliefs and behaviors
interact with and are influenced by their
broader social, geographic, and cultural
context.
▪ Used to describe the ways in which health
disparities are created and sustained.
▪ Also used to develop multilevel
interventions to address the inherently
complex nature of solutions.

There are four levels of complex systems
that affect the individual
❑ Individual Level: traits of the person that influence their
behaviors
▪ Knowledge
▪ Attitudes
▪ Beliefs
❑ Interpersonal (Microsystem) Level: made of the
interactions of individuals
▪ Influence of family/friends
❑ Community (Mesosystem) Level: connects different
microsystems together
▪ Schools
▪ Churches
▪ Organized sports
▪ Social clubs

❑ Organizational (Exosystem) Level: factors that
influence collections of mesosystems
▪ Local politics
▪ Major regional employers
❑ Environment (Macrosystem) Level: comprised of
factors that affect the system in which everyone
operates
▪ Cultural values
▪ Norms
▪ Laws
▪ Policies

Question 50

introduction to health equity approaches

Answer 50

Health equity research is relatively new.
➢ Various methodologies have been developed
or adapted specifically for health equity work.
❑ Community-based participatory
research (CBPR)
❑ Mixed-methods research
❑ Collective impact
❑ Multilevel interventions
➢These approaches provide health equity
practitioners and researchers the tools to
develop and implement strategies to
understand and achieve equity.
Health Equity
Research
Health Equity
Promotion
Work

Question 51

Community-
Based
Participatory
Research
(CBPR)

Answer 51

he gold standard for engaging communities
impacted by health disparities in impactful research.
❑ Involves partnering with communities affected by
disparities and engaging them in the research
process.
❑ The voice of the community is the driving force.
❑ Helps form sustainable community partnerships by
promoting collaboration in the development of
innovative solutions that have positive impacts on the
community.
❑ To be successful- Bidirectional relationship between
community and academic institution.
“nothing about us, without us

Three components are essential for
understanding the concept of CBPR:
❑ Action research
❑ Participatory research
❑ Community partnerships
➢Traditional research has been
investigator-driven, devoid of all three
concepts.

Question 52

action research

Answer 52

Developing solutions that directly
address the problem at hand.
o E.g., What are the removable barriers
to the outcome of interest and what
happens when they are removed?
❑ Directly connected to changing the
concept under investigation.

Question 53

participatory research

Answer 53

Ensures that impacted individuals play an
active role in shaping the project.
❑ What are the impacted individuals saying
about ways in which the problem can be
addressed?
o E.g., What do breast cancer survivors identify as
ways to decrease depression in
women post-mastectomy, and
how would they design an
intervention to do so?

Question 54

participatory action research (PAR)

Answer 54

Combines the action and participatory
components of CBPR.
❑ Depends on the notion that those who are
impacted by the outcome of interest will in
turn impact the outcome.
❑ How can we establish a breast cancer survivor
research network to develop and implement
prevention strategies?
❑ Looks at how community research networks
can be established to develop and implement
intervention strategies.

Question 55

Community Partnership

Answer 55

Encourages community involvement.
❑ Community placed
oPhysically moving the research to the impacted
community
oGoing to the community rather than have the
community come to you
❑ Involves actively engaging the impacted
community in the design, conduct,
interpretation, or dissemination of research
findings.
❑ Empowers individuals to be agents of change.
❑ E.g., new substance abuse prevention program in
the community.

Question 56

Engaging in CBPR involves a 6-step procesS

Answer 56

❑ Step 1: Form partnerships
❑ Step 2: Assess the community’s strengths and
dynamics
❑ Step 3: Identify priority health concerns and
associated research questions
❑ Step 4: Design and conduct epidemiologic,
intervention, and/or policy-related research
❑ Step 5: Feed results back to all partners and
collaboratively interpret research findings
❑ Step 6: Disseminate and translate the research
findings to a broader audience

Question 57

Mixed methods

Answer 57

Has existed for decades.
➢ Closely tied to the field of behavioral
intervention development.
➢ Well suited for health equity studies.
❑ Data gathered in a study can be diversified.
❑ Multiple sources of data can be triangulated.

qualitative research - data collected through unstructured open ended tex and verbal responses - 1-1 interviews, focus groups, surveys

quantitative research - data collected through structured and controlled instruments like surveys or experiments

Question 58

mixed methods cont.

Answer 58

Involves collecting and analyzing data,
integrating the findings, and drawing
inferences using both qualitative and
quantitative approaches in a single study
or a program of inquiry.
❑ Provides the opportunity to simultaneously
examine research questions that are both
participatory and preplanned.
❑ Also provides the chance to draw insider vs.
outsider perspectives (Emic vs. Etic).

What do you need to know about
this?
❑ Multiple data sources: Surveys & Interview.
❑ You must integrate the findings of both data
sources for true mixed methods research.
❑ In this example, we used what we learned in
the surveys to inform the questions we ask in
the interview, and then we use the data from
both to make conclusions.

The core of mixed methodology’s power in
health equity research is the ability to integrate
insider and outsider perspectives while combining
participatory and preplanned research questions.
❑ Use of a qualitative component has several
implications for health equity research.
o Individuals impacted by the outcome of
interest can have their voices heard.
o Promotes inclusivity through the
incorporation of the different perspectives
presented by the impacted community

Question 59

collective impact

Answer 59

When a group of important actors from
different sectors commit to a common
agenda for solving a specific social
problem.
❑ Supports the implementation
of the large social change
initiatives that are necessary
for achieving health equity.
❑ Enables organizations to not only
coordinate the overall impact of what they
seek to accomplish, but also enhance and
expand on the work of their collaborators.

Collective impact is guided by five key
principles
❑ Common agenda - x shared vision; conducts collaborative
strategic plan to develop mutually-endorsed
action plan

❑ Shared measurement - ground for how success will be
measured

❑ Mutually reinforcing
activities - Cohesive plan that builds intersections and
synergy across agencies

❑ Continuous communication - Full transparency and openness, trust, and
buy-in are continually reinforced

❑ Backbone support- dedicated staff coordinates collective efforts

he overall process consists of three phases
❑ Initiate action:
▪ Kick off steering committee and begin community outreach
▪ Create baseline landscape and data mapping
▪ Secondary research on other collaboratives
❑ Organize for impact:
▪ Create a common agenda and develop a high-level goal
▪ Solicit and incorporate community perspective/voice
❑ Sustain action and impact:
▪ Begin implementing strategies and measuring indicators
▪ Continue ongoing activities to share initiative progress and
gain community input