Health Disparities Flashcards
Life expectancy by race and gender
Major inequality between race and gender
Chronic conditions by social group
Larger percentage of chronic conditions with people living below the poverty level; the less money one makes, the more chronic conditions they have.
Infant mortality by race and ethnicity
Infant mortality among black infants has been more than twice that of white infants
Prevalence of comorbidities by race and ethnicity
Minorities have higher prevalence of diabetes, stroke, and other preventable diseases when compared to their white counterparts
Health insurance and the effect on having access to health care by race and ethnicity
Blacks and Hispanics have lower coverage rates as a whole when compared to whites
National efforts to monitor health disparities
- Healthy People 2020 Goals
- National Center for Health Statistics Handbook to measure health disparities
- National Institutes of Health initiatives
- Human Resources and Services Administration
- Institute of Medicine
Local efforts to monitor health disparities
State level Healthy People and task forces
Disparity
A difference, two quantities are not equal
Inequalities in health are based on…
Observed differences or disparities in health. Ex: poor people die younger than rich people (compare death rates); smokers get lung cancer more than nonsmokers; women live longer than men
Inequities in health are based on…
Ethical judgements about the differences and inequalities
How do we summarize health disparities at the population level?
Compare between majority and minority populations, or in comparison to the general population
Cancer mortality rate
Much greater in African American populations (255.1), then Whites (199.3), then American Indian (129.3), Asian (124.2), and Hispanic (123.7)
Female breast cancer age rate
Much greater in African American populations (26.1), then Whites (18.7), then Hispanic (12.1), then American Indian (10.3), then Asian (9.8)
Infant mortality rate
Much greater in African American populations (13.9), then American Indian (9.1), then White (5.9), then Hispanic (5.8), then Asian (5.1)
Health care disparities
Racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention
Clinical uncertainty
Any degree of uncertainty a physician may have relative to the condition of the patient
Implicit nature of stereotypes
The process by which people use social categories such as race or sex in acquiring, processing, and recalling information about others
Prejudice or bias
Research suggests that healthcare providers’ diagnostic and treatment decisions, as well as their feelings about patients are influences by patients’ race or ethnicity
What determines a person’s health status?
One’s behavior (such as smoking), genetics, social circumstances, environment in which one lives, and one’s access to health care
Social and economic determinants
Income level, education, and living conditions in homes and neighborhoods; drive health disparities
Economic determinants
US adults living at or below the federal poverty level are more than 5x more likely to say they are in poor or fair health compared to those whose incomes are four times the federal poverty guideline
Education determinants
Adults without a high school diploma or equivalent are three times more likely to die before age 65 than those with a college degree
Geography and neighborhood determinants
Compared to white neighborhoods, many black urban neighborhoods have more fast food outlets, fewer grocery stores and recreational facilities, and are in closer proximity to industrial pollution such as old factories and dump sites
Stress determinants
Chronic stress is related to poverty or hardship
Lower quality care determinants
Racial and ethnic minorities often receive health care in hospitals and other facilities that offer lower quality care than other institutions
Inadequate access to care determinants
Uninsured people are less likely to get recommended care for disease prevention, such as cancer screening, and for disease management such as diabetes
How to reduce health disparities
- Recognize disparities and commit to reducing them. 2. Stratify performance data by race, ethnicity, and language. 3. Provide disparity training for providers and staff. 4. Implement a basic quality improvement structure and process upon which to build interventions. 5. Make equity an integral component of quality improvement efforts. 6. Design interventions that reduce disparities. 7. Implement, evaluate, and adjust the interventions. 8. Sustain the intervention
Common intervention strategies
Culturally tailoring programs to meet the patients’ needs, patient navigation, engaging in multidisciplinary teams in intervention delivery, actively involve families, and provide interactive education as opposed to passive didactic education.
Consolidated Framework for Implementation Research - 5 domains
Intervention characteristic (cost, adaptability), outer setting (patient needs and resources, external policy and incentives), inner setting (culture, climate/readiness for implementation), characteristics of the individuals involved (knowledge about the intervention), process of implementation (planning, engaging)
