Health Disparities

Question 1

Life expectancy by race and gender

Answer 1

Major inequality between race and gender

Question 2

Chronic conditions by social group

Answer 2

Larger percentage of chronic conditions with people living below the poverty level; the less money one makes, the more chronic conditions they have.

Question 3

Infant mortality by race and ethnicity

Answer 3

Infant mortality among black infants has been more than twice that of white infants

Question 4

Prevalence of comorbidities by race and ethnicity

Answer 4

Minorities have higher prevalence of diabetes, stroke, and other preventable diseases when compared to their white counterparts

Question 5

Health insurance and the effect on having access to health care by race and ethnicity

Answer 5

Blacks and Hispanics have lower coverage rates as a whole when compared to whites

Question 6

National efforts to monitor health disparities

Answer 6

• 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

Question 7

Local efforts to monitor health disparities

Answer 7

State level Healthy People and task forces

Question 8

Disparity

Answer 8

A difference, two quantities are not equal

Question 9

Inequalities in health are based on…

Answer 9

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

Question 10

Inequities in health are based on…

Answer 10

Ethical judgements about the differences and inequalities

Question 11

How do we summarize health disparities at the population level?

Answer 11

Compare between majority and minority populations, or in comparison to the general population

Question 12

Cancer mortality rate

Answer 12

Much greater in African American populations (255.1), then Whites (199.3), then American Indian (129.3), Asian (124.2), and Hispanic (123.7)

Question 13

Female breast cancer age rate

Answer 13

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)

Question 14

Infant mortality rate

Answer 14

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)

Question 15

Health care disparities

Answer 15

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

Question 16

Clinical uncertainty

Answer 16

Any degree of uncertainty a physician may have relative to the condition of the patient

Question 17

Implicit nature of stereotypes

Answer 17

The process by which people use social categories such as race or sex in acquiring, processing, and recalling information about others

Question 18

Prejudice or bias

Answer 18

Research suggests that healthcare providers’ diagnostic and treatment decisions, as well as their feelings about patients are influences by patients’ race or ethnicity

Question 19

What determines a person’s health status?

Answer 19

One’s behavior (such as smoking), genetics, social circumstances, environment in which one lives, and one’s access to health care

Question 20

Social and economic determinants

Answer 20

Income level, education, and living conditions in homes and neighborhoods; drive health disparities

Question 21

Economic determinants

Answer 21

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

Question 22

Education determinants

Answer 22

Adults without a high school diploma or equivalent are three times more likely to die before age 65 than those with a college degree

Question 23

Geography and neighborhood determinants

Answer 23

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

Question 24

Stress determinants

Answer 24

Chronic stress is related to poverty or hardship

Question 25

Lower quality care determinants

Answer 25

Racial and ethnic minorities often receive health care in hospitals and other facilities that offer lower quality care than other institutions

Question 26

Inadequate access to care determinants

Answer 26

Uninsured people are less likely to get recommended care for disease prevention, such as cancer screening, and for disease management such as diabetes

Question 27

How to reduce health disparities

Answer 27

1. 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

Question 28

Common intervention strategies

Answer 28

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.

Question 29

Consolidated Framework for Implementation Research - 5 domains

Answer 29

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)