Transcript Inequality in Our Healthcare System – Sarah de Guia, JD

Health for All:
Expanding Care, Saving Lives
Sarah de Guia, Executive Director
California Pan-Ethnic Health Network (CPEHN)
April 12, 2015
CPEHN: Together We’re
Stronger
Eliminating Health Disparities
Quiz Time
Question : How much do we
spend on health care?
How much does the U.S. spend per person on health care
compared to the average of the other industrialized
countries?
A. Three quarters (75%) of the average
B. The same
C. One and a half times (150%) as much
D. Two and a half times as much
E. Four times as much
Source: “Unnatural Causes…is inequality making us sick?” developed by California Newsreel based in part on a quiz
developed by Stephen Bezruchka of Univ. of Wash. Population Health forum
Answer:
D. The U.S. spends more than two and a half times as much as
other countries
• In 2011, the U.S. spent $8,508 on average per person
compared to ~$3,000-$4,500 on average of OECD countries.
• Health care spending in the U.S. represented 17.7% GDP
compared to just 9.3% GDP for OECD countries.
• The U.S. is paying a lot more than most other countries for
health care so we should be living longer, right?
Source: Organization for Economic Cooperation and Development, Health at a Glance 2013
Question: How long do we live?
Q. How does U.S. life expectancy compare to
other countries?
A. #1
B. in the top 5
C. in the top 10
D. 20th Place
E. 26th Place
Source: “Unnatural Causes…is inequality making us sick?” developed by California Newsreel based in part on a quiz
developed by Stephen Bezruchka of Univ. of Wash. Population Health forum
Answer :
E. The U.S. ranks 26th place for life expectancy
• At 78.7 years, life expectancy is more than a year
less than the average life expectancy of 80.1
years for OECD countries.
• Italy and France spend less than half as much as
the U.S. on health care yet they rank 3rd and 6th
in life expectancy
Source: Organization for Economic Cooperation and Development, Health at a Glance 2013
Why aren’t we living longer?
As one of the wealthiest countries in the world, that
spends more on health care, why aren’t we living longer?
Because…
Some explanations for this are:
1) Our fragmented health care system.
2) Adverse socio-economic conditions including higher
rates of poverty and income inequality.
3) Lack of culturally and linguistically appropriate care.
4) Lack of geographically dispersed physicians and
medical centers.
Source: National Research Council and Institute of Medicine, 2013
Our Fragmented Health Care
System
Health Insurance Coverage by Source
Individual
6%
Other Public
1%
Uninsured
20%
Dual MediCal/Medicare
3%
Employer
45%
Medicare
10%
Medi-Cal
16%
Who’s Typically Uninsured?
• Part-time workers or working in small firms
• Those living in poverty and unemployed
• 18 - 34 years old
• Latinos are disproportionately uninsured
• Foreign-born & non-citizens
Communities of Color Are
More Likely To Be Uninsured
California’s Uninsured (Pre-ACA)
A&PI: 11%
Other: 2%
White: 23%
African
American: 5%
Latino: 59%
Without Health4All Disparities
Will Persist!
Communities of color will make up 82% of the uninsured
A&PI: 11%
African
American: 3%
Other: 1%
White: 18%
Latino: 66%
Source: After Millions of Californians Gain Health Coverage after the ACA, Who Will Remain Uninsured?
After ACA: Remaining Uninsured
2,290,000
90,000
290,000
790,000
Eligible for Exchange
without Subsidies
Eligible for Exchange
Subsidies
Not eligible due to
immigration status
1,120,000
Eligible for Medi-Cal
After Millions Gain Health Coverage Under the ACA, Who Will Remain Uninsured
That’s Why We Need
Health4All!
Lack of Workforce Diversity
Spectrum of Health: Health Coverage Is Just The First Step
What does health look like?
Quiz Time #2
Question : Predictor of Health
Q. On average, which one of the following is the
best predictor of health in the U.S.?
A. Whether or not you smoke?
B. What you eat
C. Whether or not you are wealthy
D. Whether or not you have health insurance
E. How often you exercise?
Source: “Unnatural Causes…is inequality making us sick?” developed by California Newsreel based in part on a quiz
developed by Stephen Bezruchka of Univ. of Wash. Population Health forum
Answer
C. The single strongest predictor of health is our
position on the class pyramid.
• People in the highest income group can expect to live 6 ½
years longer than those in the lowest.
• Low-income adults are 50% more likely to suffer from
heart disease than top earners.
• Children living in poverty are ~7 times as likely to be in
poor or fair health than children living in high-income
households.
Source: “Unnatural Causes…is inequality making us sick?” developed by California Newsreel based in part on a quiz
developed by Stephen Bezruchka of Univ. of Wash. Population Health forum
Income and Poverty
Income
Poverty
Latinos: $45,185
Latinos: 10%
African Americans: $42,441
African Americans: 11%
American Indians/
American Indians/Alaska Natives: 13%
Alaskan Native: $41,516
Whites: 7%
Whites: $66,638
Source: Landscape of Opportunity: Cultivating Health Equity in California, June 2012
Health Inequities
• Inequities in the form of…
• Housing segregation
• Employment discrimination
• Unequal wages and other
discriminatory practices
…have created persistent health
disparities that lead to poorer
health outcomes and limit
opportunities for communities of
color in our state.
What do we do about that?
• Promote Health Equity:
• Ensure all people have full and equal access to
opportunities that enable them to lead healthy lives.
• Eliminate Health Disparities:
• Differences in health and mental health status among
distinct segments of the population, including differences
that occur by gender, age, race or ethnicity, sexual
orientation, gender identity, education or income, disability
or functional impairment, or geographic location, or the
combination of any of these factors.
Examples of Health Disparities
Latinos and Asians in
Medi-Cal are more likely
to be overweight.
Persons that
speak English not
well or at all are
more likely to be
diagnosed with
heart disease.
Examples of Health Disparities
Environmental Factors
• Communities of color and lowincome communities are more
likely to live in areas with high
exposure to pollutants which can
lead to higher levels of asthma
and other respiratory conditions.
• Residents in low-income areas
and communities of color are
often less likely to own a car, so
they may rely more on public
transportation to go to work, the
doctor, or the grocery store.
Access to Healthy Fruits and
Vegetables
• In California, people of color
have a higher ratio of less
healthy food outlets to
healthier food outlets.
• Areas with higher ratios tend
to have higher rates of obesity
and diabetes.
Access to Safe Places to Play
• A higher percentage of Whites feel
safe in their neighborhood
compared to communities of color.
• Not feeling safe in one’s
neighborhood is correlated with
increased psychological stress.
• Living in a neighborhood that is
perceived to be unsafe creates
barriers to physical activity and
social cohesion.
Policy Solutions
• Improve the quality of care and utilization of
services.
• Expand workforce to matches the needs of the
population.
• Ensure our communities promote health and
wellness.
• Expand access to all Californians regardless of
ability to pay or immigration status.
Support Health4All!!!
For More Information:
(510) 832-1160
[email protected]
www.cpehn.org