Midterm General Flashcards
sociodemographic characteristics of Hispanics/Latinos residing in the U.S
52.5 mil in U.S. in 2011, plus 3.7 mil in Puerto Rico
17% of US pop
most growth of all pop groups from 2000-2011
median age is younger for Hispanics than US pop
>50% of the nation’s Hispanics live in CA, FL, and TX
sociodemographic characteristics of Hispanics/Latinos residing in the U.S
More Hispanics ≥ 25y/o no HS degree compared to whites
Lower % of advanced degrees compared to whites
Highest uninsured rate prior to ACA
Highest fertility rate (large proportion of young persons + a high fertility rate= a high ‘natural increase’ in the Hispanic/Latino population)
Definition of Health Disparities
Differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States
DHHS initiative: Six Areas Identified as Priorities for Elimination or reduction by the year 2010
- Infant Mortality
- Cancer Management
- Cardiovascular Disease
- Diabetes
- HIV/AIDS
- Immunizations
Top-10 Hispanic Health Priority Areas:
- Cervical Cancer
- Diabetes
- No Prenatal Care
- Chronic Kidney Disease
- Teen Pregnancies (15-17)
- Incidence of Early Syphilis
- Chronic Liver Disease and Cirrhosis
- Fewer than 5 Prenatal visits
- Septicemia
- Pregnancies among women 18-19
Hispanics/Latinos have several notable health disparities when compared to non-Hispanic whites
BECAUSE Many of these disparities arise from socio-economic conditions and institutionalized policies related to prevention, access to care, and treatment
Health Equity
Fair opportunity to attain full health potential and that no groups should be disadvantaged from achieving this potential
Causes of disparities
Differences in the quality of care received within the health care system
Differences in access to healthcare, including preventative and curative services
Differences in life opportunities, exposures, and stresses that result in differences in underlying health status
Social Determinants of Health
Economic Stability, Education, Social and Community Context, Health and Healthcare, Neighborhood and Built Environment
Economic Stability
Poverty, Employment Status, Access to Employment, Housing Stability (homelessness, foreclosure)
Education
High School Graduation Rates, School Policies that Support Health Promotion, School Environments that are Safe and Conductive to Learning, Enrollment in Higher Education
Social and Community Context
Family Structure, Social Cohesion, Perception of Discrimination and Equity (man vs woman), Civic Participation, Incarceration/ Institutionalization
Health and Healthcare
Access to Health services - including clinical and preventive care, Access to Primary Care
Neighborhood and Built Environment
Quality of Housing, Crime and Violence, Environmental Conditions, Access to Healthy Foods
10 Leading Causes of Death for LATINOS in the US, 2010
- Cancer 2. Heart Disease 3. UI 4. Stroke
5. Diabetes 6. Liver Disease 7. Chronic LRD 8. Alzheimer’s 9. Nephritis 10. Flu & Pneumonia
National Prevention Strategies: Four Strategic Directions:
Healthy and Safe Community Environments
Clinical and Community Preventive Services
Empowered People
Elimination of Health Disparities
Recommendations for Eliminating Health Disparities
Ensure a strategic focus on communities at greatest risk,
Reduce disparities in access to quality healthcare,
Increase the capacity of the prevention workforce to identify and address disparities,
Support research to identify effective strategies to eliminate health disparities,
Standardize and collect data to better identify and address disparities
Healthcare Access and Utilization
Nearly 31% don't have a usual source of health care Large number of uninsured Hispanic/Latinos 34.8% Immigrant status (documented or not) puts sig limitations on employment and therefore insurance options
2 major outcome indicators of pop health
Infant mortality rates= live past first year
Longevity rates= How long you live
Doubled in US in last 100 years because we learned the
relationship between environment and health Antibiotics, germ theory and vaccines Societal changes (clean water,
clean air and housing conditions
Health Inequities
Differences in health that are unfair and avoidable
Affected by social, economic and environmental issues
Not warranted
At risk model
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At risk model criticisms
- Stigmatizes populations (gay males=aids)
- Treat pop as though they are the disease
- Attach a disease to a population
- Blaming the victim
- Reduces society’s role in risk takin behaviors
- Upstream vs downstream: need to ask more important questions of what is causing it
- Usually focused as individuals getting help and not the society
Resiliency models
Overcoming adverse conditions vs elimination of adverse conditions
focusing on individual risk factors for disease
- Eliminating one disease will not create health equity =We can cure diabetes but then there will be a new disease
- Need to make a health equitable society
- Fundamental contributors to disease and illness will not be eliminated
Who disease hits 1st
Most vulnerable (poor, low SES)
Disease prevention and management
Can increase health inequalities
Richer the ppl can afford treatments and education, can assess knowledge quicker
Health as a Human right
- As a society we do not act like this
- Requires set of social criteria that is conducive to health of all ppl, including availability of health services, safe working conditions, adequate housing and nutritious foods
Health
Social welfare+healthcare=health
Social welfare: adequate housing, food
human rights based health approaches
- Non discrimination of any kind
- Includes undocumented immigrants, gender, social class, skin color
- Available, acceptable and assessable
- Quality care–>knowledgeable nurses, doctors and healthcare team
- Accountability–making sure you are doing an effective job
- Universality–offering to everyone
- Not looking for a big profit, just looking to give out good healthcare to everyone
US healthcare system is like
patchwork of ameliorating systems
- patching up pieces
- but do not make it better as a whole
health is a _________ and a ________
commodity/ privilege
Mayflower pact
if one person can fish, we are able to eat that fish
We will do okay but some will be able to do better than others
Healers and charities
Religious orgs that aid the poor–>not the gov
Private entities
Healers–predecessors to doctors in the past
Flexner Report of 1917
made it so that doctors had to be certified to practice medicine
-no more healers
AMA (American Medical Association)
Advocated for doctors was a small businessperson
No regulation and anti social medicine
Pay your MD out of pocket
Doctor went to house, ppl wouldn’t go to the hosp (death sentences)
Roosevelt’s New Deal (1933-45)
- social security, unemployment, labor unions, regulations, GI bill
- Brings white working class (males) out of depression→ middle class
- Expanded middle class
- WWII–became most powerful and wealthy country on earth
Johnson’s Great Society (1965)
Civil Rights, Immigrant rights, Anti-discrimination, anti-poverty programs
Begins to address those still left out Latinx, blacks, asians, and women in particular poor single women and children
1980s (small gov)
Advocating for getting rid of entitlements/ rights
1950s rising cost of medical care
-Screenings
-Medicines
-Technology
-Out of pocket no longer viable
-MD autonomy solo practice no longer viable
-Usually taken over by hosp
Working with insurance companies
HMOs/insurance/multi-group practice
Hosp employee (hartford healthcare has brought out private practices)
Corporate employee (hosp have become corporations)
we have a _______ system NOT a healthcare system
disease
It relies on sickness and disease
social security act (1935)
Limited access by excluding jobs with high number of minorities
Ex: agriculture and domestics
Teachers do not get SS because they get pension
1965 amendments to SSA
Medicare (65+/disabled)
Medicaid (poor ppl including elderly)
affordable care act (2010)
Obamacare
Address high levels of uninsured ppl and underinsured ppl
Try to have ppls health taken care of before you are dying
Aimed at all americans having access to affordable and good-quality health insurance (NOT access to healthcare)
not a national healthcare system, still fragmented
-would mean we would have to eliminate big pharma/insurance companies
what did ACA create?
Center for medicare and medicaid innovation
Within CMS, wanted to make sure more effective
Patient centered outcomes research institute
See what is best for the patient
how does ACA work?
Requires health insurance
Opened health insurance marketplaces or exchanges which offer premium subsidies to lower–>middle income individuals
Those who are high risk for illness (pre existing conditions) can get regular group insurance (vs high risk insurance)
Expands of Medicaid in many states for low income adults
If state accepts–some states refused money due to being opposed to entitlements
groups that benefited most in ACA
People of color
Poor and low income
States that expanded medicaid
Documented immigrant are barred from federal programs for 5 years
PRWORA–heav to work for the money that they get
ACA requireshow many essential services covered by health insurance ?
ACA requires 10 essential services covered by health insurance
Needs to actually cover certain things, so ppl are actually covered
Dept of health and human services (HHS)
board/chair of gov that oversees; CDC, NIH, CMS, HRSA, AHRQ, and FDA
US gov provides
Health insurance (Medicaid/Medicare), protective regulations, programs, and health insurance
CHIP–Children’s Health Insurance Program
In some states is an extension of Medicaid and in others a separate programs
Covers more than 8.1 mil childrren in low income (but not officially) poor
Medicaid–for poor families
FPL–used to set eligibility criteria for medicaid, CHIP
private ways to get insurance
job that pays healthcare, acquired coverage directly (out of pocket)
undocumented immigrants in healthcare
Ineligible for federal programs and ⅔ uninsured
Hosp that accept medicare funds must provide enough care to stabilize ANY patient with an emergency medical condition
Some states allow undocumented immigrants to qualify for emergency medicaid coverage beyond stabilization care
Some state and local gov provide coverage for undocumented children/pregnant women
health delivery system
Primary care physicians account for roughly ⅓ of all US doctors (least $)
Outpatient specialist care: specialists can work in both private and hospitals (most $)
after hours care forces
ppl to use ERs (v expensive and clogs system)
Latinx variance in health profiles
Lower rates of LBW babies than white pop except puerto ricans who are 2x higher
Puerto ricans suffer disproportionately from HIV/AIDS, asthma, and infant mortality
Mexicans suffer disproportionately from diabetes
Puerto ricans mostly located in northeast
Mexicans mostly located in southwest → close in border
Asthma
Puerto ricans 2x more asthma and PR children 3 x more likely to have asthma than whites
Latinx children 2x more likely to die from asthma than white children
Asthma linked to poorly ventilated, increased pollution, urban areas
Chronic Liver Disease
2x more likely to get CLD
1.7x more likely to die with CLD
Health risk factors: alcoholism, obesity, hep b and c
Diabetes (Type 1 and 2)
1.7x more likely to be diagnosed
3x more likely to start treatment for end-stage renal disease related to diabetes
1.5x more likely to die from diabetes
Heart Disease and Cancer
Not always at higher risk, they have lower risk in general
More likely to die from it
40% more likely to get cervical cancer
Hepatitis
2nd highest rate of hep A
Lower rates of hep c but 60% more likely to die from it if they have it
Immunizations
20% less likely to have ever received pneumococcal or flu shot
40% less likely to get HPV vaccine
Infant mortality rates/10000
3 for cubans to 5.9 for PR
Mothers x more likely to receive little/no to late care
PR infants 2x more likely to die due to low birth weight
Mental health
Poverty level effects
Whites 2x more likely often to get treatment
Those below poverty level → 2x as likely to report psychological distress
Stroke
Latinos 30% more likely to have a stroke
Obestity and overweight
HTN
High cholesterol
Health inequities factors
Poverty, racism, marginalization
Language and cultural barriers,
Access to health info, healthcare, healthy environments and resources
Targets for manufacturers of illness
Soda companies, candy companies, junk food–gives you addictions to food/ unhealthy habits
1/4 of all diseases are
linked to environmental factors like pollution and contaminated water
Morbidity and mortality
Gov agencies monitor rates of illness and deaths in populations and among subgroups
Can do it based on gender, race/ethnic groups, geographic locations
Healthy people
Tracking pop health
Concept came from Canada that sets goals on improving pop health every 10 years, it’s snapshot of those yrs
Gov doc with community input
Lack of vaccination led to outbreak of curable disease, risks of immunization vs no immunizations
Racism gets into biology
