Transcript Health Disparities

Health Disparities
Why we have not solved the problems
Why we need new approaches
Bill Jenkins, Ph.D., M.P.H.
The Research Center on Health Disparities
Morehouse College
• Why we have not solved the problems of
Health Disparities?
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Blac ks
Whites
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Infa nt de a ths pe r 1,000 live births
Infant Mortality Rates by Race:
United States, 1915-1997*
Year
*Note: For years 1915-1960, “White” included persons stated to be “White,” “Cuban,”
“Mexican,” or “Puerto Rican.” All others during that time period were referred to as
“Nonwhite.”
5
4.5
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B/W Ratio
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2
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1
0.5
0
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Ratio of Infant deaths per 1,000 live births
Black-White Ratio of Infant
Mortality,United States: 1915-1997*
YEAR
*Note: For years 1915-1960, “White” included persons stated to be “White,” “Cuban,”
“Mexican,” or “Puerto Rican.” All others during that time period were referred to as
“Nonwhite.”
A Model of Health Disparities
30-30-30
Socio-Economic Factors
+ 30 Percent
Racism Factors
+ 30 Percent
Cultural Factors
+ 30 Percent
Medical Care Factors
+ 10 Percent
Biological Factors
+ 1 Percent
= Attributable Risk Percent
Racism
• Racism remains a pervasive force in America today.
Although more benign, it remains a major
determinate of health and health policy in America.
The most deleterious form of racism is subtle and
complex as it interacts with socio-economic status,
culture and a host of political and other factors –
White Privilege.
• There is no social force more pervasive, yet so
misunderstood than racism. It creates the illusion
that there is something called “Race” and then
establishes assumptions to support it. So powerful a
concept that even those who are disadvantaged by it,
accepts it – the use of race supports racism,
especially when used by African-Americans.
Racism
• There is no “race” problem in America, There
is a Racism problem. If you can not define a
problem, you can not solve it – To many of us
are afraid to use the word –
• A social “construct” – not to the other 99 % of
Americans.
• The greatest problem using the term race it
that it influences us to waste huge amounts of
resources on issues which no or little chance
of solving the problem: Genetics, Health care
It’s the culture - Stupid
African-Americans most understand themselves
and be understood by others as an ethnic group –
competitive dance,
• The problem of health care utilization is much
less accessibility than acceptability of health care
• Racial data has largely been changed to ethnic
data already, but most people have not noticed
• Solving the problem of health disparities requires
that we address the problems of Culture including issues of trust, competing risks,
internalized racism….
Socio-Economic Status
• SES remains perhaps the most powerful
force producing health disparities – it is
massive, multi-factorial, complex .
• There is no will to solve this problem head
on, however there are solutions which go
un- and under utilized – head start,
community participatory activities
• How can we solve the problems of Health
Disparities?
AIDS Case Rates per 100,000
Population by Ethnicity: United
States, 1990-2000
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Case Rates/100,000
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0
1990
1991
White, non-Hispanic
Asian/Pacific Islander
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1993
1994
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1996
Year
Black, non-Hispanic
American Indian/Alaska Native
1997
1998
1999
2000
Hispanic*
*Persons of Hispanic origin may be of any race.
AIDS Rate Ratios by Ethnicity as
Compared to Whites: United States,
1990-2000
10
9
8
Rate Ratios
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Year
Black, non-Hispanic
Hispanic*
Asian/Pacific Islander
American Indian/Alaska Native
*Persons of Hispanic origin may be of any race.
Primary and Secondary Syphilis Reported
Rates per 100,000 Population by Ethnicity:
United States, 1995-1999
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Rate
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0
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1996
1997
1998
1999
Year
White
African American
Hispanic
Asian/Pacific Islander
American Indian/ Alaska Native
Primary and Secondary Syphilis Rate
Ratios by Ethnicity Compared to
Whites: United States, 1995-1999
60
Rate Ratio
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40
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0
1995
1996
1997
1998
1999
Year
African American
Hispanic
Asian/Pacific Islander
American Indian/ Alaskan Native
Levels of Community Participatory Research
• Community notification - inform the community of the
intentions of the research risks and benefits relating to
the individuals and communities involved
• Community endorsement - community representatives
are asked to formally support the research activities
• Community advice - seeking and obtaining community
advice in planning, development, execution, and
dissemination of the research.
• Community consent - obtaining some expression of
community approval.
• Community origination - research purpose and goals set
by expressed community needs.
The Tuskegee Study of Untreated Syphilis in the
Negro male (1932-1972): An example of CPR
• Community Notification
Churches / Businesses
• Community Endorsement
Business Establishments
• Community Advice
The Tuskegee Institute
• Community Consent
Macon County Medical Society
• Community Origination
The Negro Health Movement
• Cultural Competence
Nurse Eunice Rivers
Barriers to CPR
• Respect for Community Competencies
• Willingness to share (Power)
• Accepting another perspective
Things We Can Do
• We can reduce the effect of SES on health through
ethnic-specific interventions which include social
support
• We can improve our cultural competence
• We can target low social capital communities; if
not we increase health disparities
• We can target resources to problems (less than
10% of the disparities are due to differences in
health services, but more than 70% of research
dollars are directed there)
• We, or just one of us, can make a difference