Health Disparities Flashcards
What were the 7 objectives of this presentation?
- •Define health disparities and cultural competence
- •Examine U.S. standing in world healthcare
- •Discuss socioeconomic factors and inequities that contribute to health among minorities
- •Discuss medical inequalities within the healthcare system
- •Discuss physical therapy’s role in addressing health disparities
- •Recognize and Inhibit Ethnocentrism
- •Discuss how to perform a skillful and culturally sensitive assessment: LEARN model
quote for your consideration
“Medical statistics will be our standard of measurement: we will weigh life for life and see where the dead lie thicker, among the workers or among the privileged.”
-Rudolf Virchow, 1848
What is a health disparity?
•CDC definition of health disparities:
- •“Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations”
Aka: Preventable differences that are brought about by society that affect different groups.
Name some factors that can contribute to health disparities (7)
- Race,
- ethnicity,
- gender,
- age,
- sex,
- religion,
- socioeconomic status
Life expectancy chart: where does the USA rank?
34th
Life expectancy chart: what are the three top countries for life expectancy?
first: Japan
Second: Switzerland
Third: Austrailia
(Slovenia, Chile, and Cuba all have higher life expectancy on the chart than the USA)
Life expectancy: What is the life expectancy in years for Japan, for the USA?
- The highest life expectancy: Japan ~83 years
- U.S has a life expectancy of ~78 years
where is the US ranked in the world for health expectancy
What is the US rank of infant mortality?
•U.S health expectancy is 29th in the world with an infant mortality ranked 30th
What is an interesting fact about Japanese compared to Americans in life expectancy and health behavior?
The japanese smoke twice as much as Americans but still live on average 4 years longer
How much does the USA spend on healthcare compared to other countries?
- U.S spends more than any other nation in the world on health care
- Twice the average of other industrialized countries
Out of all “rich” countries, US has the highest of the following: (9) GaP C2HIT
- Gap between high and low mortality rate within a country
- People living alone
- Child poverty rate
- Child injury death rate
- Homicide rate
- Hours worked
- Infant mortality rate
- Incarceration rate
- Teenage birth rate
How much does the US spend each year on health care?
US spends $2 trillion dollars a year on health care
Summarize financial inequality in the USA
U.S. has the most inequality in the industrialized world along with the poorest health
top 1% holds as much wealth as the bottom 90%
T/F: Health inequalities are natural, arising from decisions we as a society have made
False
•Health inequalities are not natural and arise from decisions we as a society have made
what is the single strongest predictor of health statius?
•SES (socioeconomic status) is single strongest predictor of health status
- Wealthier individuals → longer, healthier lives due to better access to higher quality medical care
People in the highest income group can expect to live on average:
- Compared to middle income group
- compared to lowest income group
•People in the highest income group can expect to live on average:
- 2 years longer than those in the middle
- 6.5 years longer than individuals in the lowest
Compare life expectancy for college graduates to life expectancy of those who didn’t finish high school
College graduates can expect to live 5 years longer than those who didn’t finish high school
**I looked it up and it looks like the ppt had a typo and that it should be 5 years longer, not five times longer.
Race: how do minorities typically compare to caucasions?
poorer health
lower life expectancy
Compare uninsured rates in hispanics, african americans, and caucasions
•1 in 3 Hispanics & 1 in 5 African Americans are uninsured compared to 1 in 8 Caucasians
Compare likelihood person will receive medical care if they are insured or uninsured
•Uninsured individuals are 6X less likely to receive medical care for a health problem than insured
compare percentages of childeren living below the poverty line for the following groups:
- African Americans
- Native Americans
- Latino
- White
What is the poverty line?
•Children living below the poverty line:
- •33% African American
- •29% Native American
- •28% Latino
- •9.5% White
Poverty line: $20,650 for family of 4 in 2007
Can you come up with 5 examples of environmental contributors to health disparities?
- Access to supermarkets and fresh foods
- Well-funded schools with variety of clubs/activities
- Safe parks or sidewalks to use
- Clean drinking water
- Safe neighborhoods/housing
What are 4 risk factors for health disparity?
- Transportation
- Housing disparities
- Lack of Food security
- Other
- examples: Transgender, LGBT
- (may be predjudice or lack of experience of caregiver)
- This poplulation less likely to seek healthcare
- examples: Transgender, LGBT
What are 5 things that can contribute to lack of Food Security
- Food deserts (no fresh food source in a certain area, like no grocery stores)
- Marketing
- Healthier food is generally more expensive
- Junk food is cheaper and lasts longer
- Individuals can have limited time to shop and prepare meals
____________ ________________ play as big of a role to our health as genetics, lifestyle choices, and even medical care
•Social conditions play as big of a role to our health as genetics, lifestyle choices, and even medical care
- •Even if individuals want to make healthier choices, they may not have the option
What are 5 factors contributing to medical inequalities within the healthcare system?
•Multiple factors contributing to disparities:
- Linguistic barriers
- •Lack of interpretation services
- Poor communication within the healthcare system
- Higher enrollment of minorities in lower-cost health plans
- •Typically offer worse benefits
- Minorities receive lower quality of care
- Minorities are less likely to seek care
does equal level of insurance eliminate disparities in health services between minorities and whites?
no
Even when level of insurance is equal between racial or ethnic groups:
- •Minorities receive lower quality of care
- •Minorities are less likely to seek care
In what clinical settings, are disparities found?
include 4 examples
•Disparities are found across a range of clinical settings
- •Public and private hospitals
- •Teaching and non-teaching hospitals
What are three issues that can affect a physician’s fervor to treat? BUS
•Literature shows that there are several issues that can influence a physician’s fervor to treat
- Bias or prejudice against minorities
- Greater clinical Uncertainty when interacting with minority patients
- Stereotypes or Beliefs held about the behavior or health of minorities
What is an example of how african americans are more likely than whites to receive less desirable services?
•Amputation of all or part of limb
T/F: the top three causes of death in the US are the same for African Americans and whites?
true, but the death rate for African Americans is higher
What are the top three causes of death in the US, and how much higher is the death rate among african americans compared to whites?
•Top three causes of death in the US are the same for African Americans and whites, but death rates among African Americans are higher
- Heart disease 30% higher
- Cancer 30% higher
- Stroke 40% higher
Compare emergency room use in African Americans and whites
•African Americans use the emergency department at twice the rate of whites
List the percentage of people in the following groups who do not have a regular physician:
- Hispanics
- African Americans
- Whites
•No regular physician
- •50% Hispanics
- •More than 25% of African Americans
- •20% of Whites
Compare diabetes in African Americans and American Indians vs whites
•Diabetes
- •African American are 15% more likely than Whites
- •American Indians suffer from diabetes 2x the rate of whites
Compare Cancer in African Americans vs whites:
- cancer death rate
- prostate cancer
- breast cancer
African Americans
- Most likely to develop and die from cancer
- 50% more likely to suffer from prostate cancer than whites
- Lower rate of breast cancer but higher death rate than white women
Which chronic disease shows the most extreme disparity of all chronic disease?
- Compare african americans and whites
- compare hispanics and whites
- HIV: most extreme disparity of chronic diseases
- African Americans 7x the rate of whites
- Hispanics 2.5x the rate of whites
What are 4 programs/policies in place that attempt to brige the gap between high and low income?
•Policies that attempt to reduce the gap between high and low income
- •Affordable Care Act
- •Increasing minimum wage
- •Food stamps
- •Welfare
What is stigma?
•Stigma: negative and often unfair beliefs that a society or group of people have about something
What is Predjudice?
List 7 common types
- Prejudice: an unfair feeling of dislike for a person or group because of sex, race, religion, etc.
- Types of prejudice:
- •Racism
- •Sexism
- •Ageism
- •Classism
- •Cultural
- •Ableism
- •Sizeism
What are two things we can do as PTs to minimize stigma and predjudice?
- •As PTs, we need to be aware of our biases
- •Don’t blame patient for failed treatment
- •Obese
- •Drug abuse
- •Smoking
What are 6 things PTs can do to help reduce health disparities?
- PTs should be able to recognize red flags and risk factors of disease (help with screening)
- Treatment is most effective in early stages of disease
- Preventative Care is Paramount
- Advocate & Vote:
- Meaningful reform must invest in prevention and wellness and ensure all Americans have access to high quality,
- •Engage in research to promote health equity
- Epidemiological study of the sources of these health inequities and address these root causes
- Build a good rapport with all pts:
- A good rapport with patients is invaluable to quality of care
- Collaborate with other professions to achieve this goal: lawyers, political groups, health inspectors, businesses, etc.
- Ensure that health care practices themselves are promoting conditions that abolish inequalities
Why must we advocate and vote?
What are 5 points about where to advocate and what to advocate for?
Advocate & Vote: Meaningful reform must invest in prevention and wellness and ensure all Americans have access to high quality, affordable care
- •Local, state, and federal levels
- •Address or draw attention to inadequate conditions in the community
- •Adequate funding for health care institutions that serve poor and minority communities
- •Requiring cultural competency training for health care professional licensure
- •Early education (put it in the syllabus in school)
What is Ethnocentrism?
•Judging another culture solely by the values and standards of one’s own culture
Ethnocentrism: What are 4 things that are commonly unfairly judged?
Ethnocentrism: Judging another culture solely by the values and standards of one’s own culture
- Language
- Behavior
- Customs
- Religion
What are 4 ways to inhibit Ethnocentrism?
- •Integrate cross-cultural education into training of professionals
- •Promote consistency and equality of care
- •Enhancing patient-provider communication
- •Promote use of interpreter services where community need exist
Case 1: African American woman, mid fifties, uncontrolled diabetic, rural setting
come up with possible risks pertaining to that patient getting adequate care (3)
- •Lack of access to diverse nutrition options
- •Lack of access to adequate healthcare
- •Possible difficulty of travel (personal or public transportation)
Case 2: Hispanic male, mid twenties, diagnosed with HIV, recently unemployed
come up with possible risks pertaining to that patient getting adequate care (4)
- •Lack of financial means to pay for proper healthcare, lack of insurance because of unemployment
- •Lack of knowledge of social support systems (ex: where free clinics are)
- •Possible language barrier
- •Possible stigma of diagnosis if he discloses it
Case 3: Asian woman recently moved to America, early seventies, urban setting, diagnosed with breast cancer
come up with possible risks pertaining to that patient getting adequate care (4)
- •Possible language barrier
- •May lack support system
- •Possible financial difficulties
- •Possible lack of insurance
What is a model that can help us with how to perform a skillful and culturally sensitive assessment:
LEARN model
What is cultural competence?
How does it relate to us as PTs and members of society? (2)
•The ability to understand, appreciate, and interact with persons from cultures and/or belief systems other than one’s own based on various factors
- •Something all people should strive for
- •Especially important in our careers
What is the name of the tool that allows pts to rate how culturally competent a medical faciility is?
Iowa Cultural Assessment – allows patients to rate how culturally compentent a medical facility is
What are 5 Key Elements to becoming Culturally Competent?
- Institutionalize Cultural Knowledge
- Ability to Culturally Self Assess
- Value Diversity
- Provide Services Reflecting Cultural Differences
- Conscious of how Cultures Interact
What are two big models about cultural competence?
which was emphasized in the presentation?
- •Cross model: attitudes, behaviors, and policies come together with a consistency that allows appropriate healthcare treatment across all cultural situations.
- •Campinha-Bacote model: The provider aims to effectively treat patients within the cultural context of the individual, family, and community.
Campinha-Bacote model was emphasized
List Five key constructs of Campinha-Bacote model
(neumonic: Cultural: ASKED)
- •Cultural Awareness: Am I aware of my biases and prejudices?
- •Cultural Skill: Do I have the skill of conducting a cultural assessment in an sensitive manner?
- •Cultural Knowledge: Am I knowledgeable about the worldviews of different culture and ethnic groups?
- •Cultural Encounter: Do I seek out interactions with individuals who are different from myself?
- •Cultural Desire: Am I committed to engage in the cultural competence process?
What are the 5 components of the LEARN model?
- Listen: Greet everyone involved, don’t interrupt, and begin with open-ended questions. Be sensitive to those not proficient in English.
- Elicit: their views of their health and their goals for their treatment.
- Assess: effects of patient health from multiple sources in their life
- Recommend: plan of action
- Negotiate: plan of action with patient
What are 6 key points to remember from this presentation?
- Health inequalities are not natural and arise from decisions we as a society have made
- Multiple factors contribute to health disparities
- Preventative care is paramount to detecting diseases in their early stages when treatment is most effective
- Strive to have cultural competence in all aspects of care
- Consider the LEARN model for effective communication
- Enhancing cultural competence of clinicians and clinics may reduce health care disparities
