Transcript Slide 1

Hispanic Health in
the United States
Judy Monroe, MD
Deputy Director
Centers for Disease Control and Prevention
March 18, 2011
Edward Roybal
1822–1995
CDC is better aligned to address
public health priorities…
•
Excellence in surveillance, epidemiology, and
laboratory services
•
Strengthen support for state, tribal, local, and
territorial public health
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Increase global health impact
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Use scientific and program expertise to advance
policies that promote health
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Better prevent illness, injury, disability, and death
Winnable battles
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Each area is a leading cause of illness, injury,
disability, and death
•
Evidence-based, scalable interventions
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Our efforts are likely to make a difference
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We can get results within 1 to 4 years―
but none are easy
Key winnable public health battles
for the United States
Tobacco
HealthcareAssociated
Infections
Teen
Pregnancy
Nutrition,
Physical Activity,
Obesity and
Food Safety
Motor
Vehicle
Injuries
HIV
Tobacco
•
•
Progress stalls starting in 2004
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Prevalence of current smoking among
adults, US, 1997–2009
Tobacco is the
leading preventable
cause of death
After 40 years of
progress, the
decrease in adult
smoking rates has
stalled in the past 6
years
But most people
who have ever
smoked have
already quit, and
most of today’s
smokers want to quit
Nutrition, physical activity,
obesity, and food safety
Obesity rates, 1960–2008
Obesity prevalence
40%
10%
0%
Since the 1960s, obesity
rates doubled for adults
and tripled for children
•
>36% of adults (>72
million) and 17% of
children are obese
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Each year, foodborne
diseases sicken 1 out of
6 Americans and cause
>$9 billion in health carerelated costs
Adult
30%
20%
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Child 12–19
Healthcare-associated
infections
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Inpatient hospital setting
•
•
•
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1 out of 20 patients contracts an HAI
100,000 patients die/year from an HAI
HAIs costs range between $26–$33
billion/year
Outpatient settings (eg, dialysis,
laboratory, long-term care)
•
Patients can acquire bloodstream
infections in these settings
At least 1/3
of HAIs are
preventable
with simple,
existing
tools
Motor vehicle injuries
Causes of death among people
ages 5–34, U.S., 2007
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Motor vehicle crashes
are leading cause of
death among Americans
ages 5–34
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Despite progress, U.S.
rates of death from car
crashes are twice rates
of other countries and
could be reduced by
simple, low-cost methods
22%
43%
12%
12%
11%
MV crashes
Suicide
All other
Homicide
Poisoning
Teen pregnancy
1970
80
70
60
39%
2006
Rates are far lower and are decreasing
much faster in other countries
50
80%
40
68%
30
81%
82%
20
10
80%
0
U.S.
Norway
France
Denmark
Switzerland
Sweden
HIV
HIV continues to spread
despite being preventable
Estimated number of new HIV infections by
transmission category, U.S.,1977–2006
Source: Hall Irene et al. Estimation of HIV Incidence in the US. JAMA 2008 Aug 6; 300(5): 520-529
The excess medical cost of diseases
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Diabetes: +$6,600
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Obesity: +1,430
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Tobacco: +$1,400 is
increment of current vs
former smoker; $2,400
is increment of current
vs never smoker
Factors that affect health
Examples
Smallest
Impact
Counseling
& Education
Clinical
Interventions
Long-lasting
Protective Interventions
Eat healthy, be
physically active
Rx for high blood
pressure, high
cholesterol, diabetes
Immunizations, brief
intervention, cessation
treatment, colonoscopy
Changing the Context
To make individuals’ default
decisions healthier
Fluoridation, 0g trans
fat, iodization, smokefree laws, tobacco tax
Socioeconomic Factors
Poverty, education,
housing, inequality
Largest
Impact
Hispanic population in U.S.
increased 29% from 2000 to 2009
Population in millions
60
Hispanics represent 16% of U.S. population
48
50
40
35
30
22
20
10
15
10
0
1970
Source: U.S. Census Bureau
1980
1990
2000
2010
The majority of Hispanics
living in the U.S. are from Mexico
1%
4%
3%
6%
6%
8%
9%
65%
Mexican
Puerto Rican
Central American
Other Hispanic
South American
Cuban
Dominican
Spaniard
Numbers are rounded up
Source: U.S. life tables by Hispanic origin, CDC, October 2010
Hispanics experience lower health status
Hispanics have
disproportionate
health needs
compared with other
racial or ethnic groups
in the U.S.
Inequalities in health status in the U.S. are
large, persistent, and increasing…poverty,
income and wealth inequality, poor quality of
life, racism, sex discrimination, and low
socioeconomic conditions are the major risk
factors for ill health and health inequalities
National Association of County and City Health
Officials Health and Social Justice Committee
Hispanics have higher life
expectancy than whites or blacks
Life expectancy at birth, U.S. 2006
90
80
83
80
78
76
76
69
Age in years
70
60
50
40
30
20
10
0
Hisp. female White female Hisp. Male Black female White male
Source: CDC/NCHS, National Vital Statistics System, 2006
Black male
Yet they face many health disparities
Disproportionate disease burden linked to
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Low education
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Language and cultural barriers
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Poor access to preventive care and health
insurance
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High poverty
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Unsteady/poor/unsafe working conditions
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Precarious social status
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Use of unconventional medicine
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Cultural views on health
More than twice as many Hispanics
as whites live below poverty level
Adults ≥18 years who live below federal poverty level
25%
23%
21%21%
20%
20%
19%
18%
2005
2009
15%
10%
11%
10%
8% 8%
5%
0%
White
Black
Asian/Pacific
Islander
AI/AN
Source: CDC Health Disparities and Inequalities Report 2011, MMWR, Vo. 60
Hispanic
Four times as many Hispanics as whites
do not complete high school
50%
Adults ≥18 years who did
not complete high school
45%
40%
2005
2009
43%
39%
35%
30%
27%
25%
21%
18%
20%
15%
10%
21%
14%13%
11%
9%
5%
0%
White
Black
Asian/Pacific
Islander
AI/AN
Source: CDC Health Disparities and Inequalities Report 2011, MMWR, Vo. 60
Hispanic
Hispanics adults have the highest
rate of uninsured of any group
Adults 18–64 without health insurance, U.S., 2008
45%
42%
40%
34%
35%
30%
25%
22%
20%
15%
15%
14%
10%
5%
0%
White
Black
Asian/Pacific
Islander
AI/AN
Source: CDC Health Disparities and Inequalities Report 2011, MMWR, Vo. 60
Hispanic
Lower-income Hispanic children are
twice as likely as whites to be uninsured
Percentage of children without
health insurance, U.S., 1998–2001
Source: 1998–2001 National Health Interview Surveys
Top 10 leading causes of
death for Hispanics, 2007
Heart disease
29,021
Cancer
27,660
Unintentional injuries
1.5
1.6
11,723
Stroke
7,078
Diabetes
6,417
Chronic liver disease & cirrhosis
3,913
Chronic lower respiratory diseases
3,531
2.5 Homicide
3,466
Conditions origin. in perinatal period
2,946
Influenza & pneumonia
2,735
0
Source: Health, US, 2009
10,000
Age-adjusted death
rates are greater for
Hispanics than for
whites in 3/10 leading
causes of death
20,000
30,000
40,000
Puerto Ricans have highest rates of
asthma and Mexicans have lowest
Asthma
prevalence,
U.S., 2009
Mexican
Adults 18–64 without
insurance,
U.S., 2008
5 health
Puerto Rican
17
Total Hispanic
6
8
White
0
5
10
Source: National Health Statistics Report, Nr 32, January 12, 2011
15
20
Hispanic teens engage in
high-risk behavior more
frequently than whites or blacks
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34% rode in car driven by someone who drank
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15% seriously considered attempting suicide
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8% attempted suicide
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19% smoke
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14% used inhalants
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9% used cocaine in past and 4% use now
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8% used ecstacy in past
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6% used methamphetamines
Source: 2009 Youth Risk Behavior Surveillance System
Since 1995, Hispanic girls have had
the highest birth rate of any group
Rate per 1,000 girls in specified age group
140
120
U.S. birth trends by race/ethnicity
girls 15–19, 1991–2009
100
80
60
40
20
0
Source: National Center for Health Statistics
Hispanic
Black
AI/AN
White
Asian/Pacific Islander
Teenage childbearing varies
widely among Hispanic groups
Birth by race and Hispanic origin
for girls < 18, 1980–2007
12.0
Puerto Rican
Mexican
Cuban
Central & S.
American
Percent of live births
10.0
8.0
6%
6.0
4.0
2.0
0.0
2%
1980
1982
1984
Source: Health, US, 2010
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
20062007
CDC is working in communities
with high teen birth rates
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Enhancing community partnerships and
improving access to family planning
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Promoting evidence-based prevention programs
and policies
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Working with diverse communities—especially
Hispanic and black youth
Grantees are funded, in part, through a collaboration with the HHS Office of Adolescent
Health, President’s Teen Pregnancy Prevention Initiative and the Office of Population
Affairs, Title X Program.
CDC teen pregnancy
prevention grantee activities
Hartford, CT, Health and Human Services
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Collaborate with CBOs and clinic partners that serve
Hispanics in area

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Population is 41% Hispanic; 38% black
Implement ¡Cuidate! in English and Spanish

Evidence-based intervention to reduce sexual risk behavior related to HIV
infection among Hispanic youth
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Increase bilingual communications efforts with targeted
teen pregnancy prevention public awareness campaigns
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Sponsor parent education
CDC teen pregnancy
prevention grantee activities
Fund for Public Health in New York
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Work in South Bronx, Community District 2 and 3
•
•
Population of 15−19 year old Hispanic youth is 65%
Implement Reducing the Risk in 9th grade through school
system
South Carolina Campaign to Prevent Teen
Pregnancy
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Provide training and technical assistance to partner
organizations on the ¡Cuidate! curriculum
CDC teen pregnancy
prevention grantee activities
Massachusetts Alliance on Teen Pregnancy
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Collaborate with CBOs and clinical partners that serve
Hispanic populations in Springfield/Holyoke
•
•
Partner with the YEAH Network
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Predominantly minority population (65% black and/or Hispanic) female ages
15−19
Focus on reducing racial and ethnic health disparities and improving
reproductive health for Hispanic youth
Implement ¡Cuidate!
CDC teen pregnancy
prevention grantee activities
University of Texas Health Science Center,
San Antonio
•
Work in south and southwest portion of Bexar
County (San Antonio)

Population is >90% Hispanic
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Work with 15 Hispanic youth serving CBOs to
implement evidence-based programs
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Translate all curricula and information into Spanish
Estimated percentage of new HIV
infections by race/ethnicity, 2006
Asian/Pac. Isl.
2%
American
Indians/Alaska
Natives
1%
Hispanics
17%
Blacks
45%
Whites
35%
N = 56,300
Source: CDC surveillance data; Hall JAMA 2008
HIV among Hispanics
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Diagnoses of HIV infection among Hispanics
decreased from 2006−2009
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In 2009, the rate was 23 in Hispanic population
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Hispanics are 3 times more likely to be living with
HIV than whites*
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Hispanics account for 17% of new infections and
18% of people living with HIV
Source: CDC, HIV Surveillance Report,2009
(ww.cdc.gov/hiv/surveillance/resources/reports); Purcell National STD Prevention
Conference 2010; National HIV Behavioral Surveillance System, Denning IAS 2010; *40
states with mature HIV reporting, year-end 2008;
CDC HIV prevention
activities for Hispanics
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Work with local communities and health care
providers to increase HIV testing, early diagnosis,
and access to care for Hispanics
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Implement routine testing recommendations and
expand testing in non-medical settings
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Provide training for researchers of minority
ethnicities via the Minority HIV/AIDS Research
Initiative
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Expand access to effective prevention programs to
reach a broad spectrum of Hispanic populations
State-specific prevalence of obesity
among Hispanic adults, 2006−2008
20−24
25−29
Source: CDC Behavioral Risk Factor Surveillance System
30−34
35+
More than 75% of Hispanic adults have
unhealthy weight (38% are overweight and
39% are obese)
Source: Flegal K et al. Prevalence and trends in obesity among US adults, 1999-2008. JAMA 2010; 303(3):
235-241
Hispanics have high rates of
overweight and obesity
•
Ranged from 21% (Maryland) to 37% (Tennessee)
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Adult obesity rates for Hispanics are higher than those for
Whites in most states*
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Adult obesity rates for Hispanics are ≥30% in 11 states*
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Obesity rates for Hispanics high school students are 10%
higher than for white students*
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40% of Hispanic mothers and 38% of Hispanic toddlers are
overweight or obese**
Source: *F as in fat: How obesity threatens America’s future, 2010
** Racial and ethnic differentials in overweight and obesity Among 3-year-old children,
Am J Public Health, Feb 2007;97:298-305
Control prevalence and treatment
for hypertension and cholesterol
are low for Mexican Americans
60
Prevalence
Treatment
Control
Percentage
50
40
30
20
10
0
Hypertension
Cholesterol
Source: Vital Signs, February 2011. www.cdc.gov/VitalSigns/CardiovascularDisease/index.html
38% of Hispanic children
are overweight or obese
Cultural food intake
factors
•
Equating overweight
with healthiness in
children
Gorditos y colorados
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Use of food treats by
parents as token of love and caring
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Taking a bottle to bed (14% do vs. 4% for blacks
and 6% for whites)
Data for children between 2 and 19 years of age
Hispanics have the highest risk of
developing diabetes of any group
75
Percentage
60
Estimated lifetime risk of developing diabetes
for individuals born in the U.S., 2000
49
45
53
45
40
39
33
27
30
Men
Women
31
15
0
Total population
Source: Narayan KMV, JAMA, 2003
White
Black
Hispanic
Mexican dishes are high in sodium
•
Hispanics aged 2 and older consume 3,097 mg
of sodium per day
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Mexican mixed dishes contribute
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7% of sodium intake in the diet of the general
population
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11% of sodium intake in the diet of the MexicanAmerican population
Americanized Mexican food is high in
calories, fat, and salt
•
Rubio's Fresh Mexican Grill
Carne Asada Taco with rice
and beans: 710 calories and
22 g of fat
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Taco Bell Nachos Bell
Grande: 770 calories and 39
g of fat
•
Baja Fresh Steak quesadilla:
1,450 and 86 g of fat
Source: F as in fat: How obesity threatens America’s future, 2010
Beef burrito
Calories: 830
Saturated fat: 10.5 g
Cholesterol: 95 mg
Sodium: 1,570 mg
Sugar: 1 g
Age-adjusted prevalence of diabetes and
percentage at high risk for diabetes (IFG), by
country of residence: 2001−2002
25
Diabetes
Percentage
20
15
IFG
17
14
15
14
14
9
10
5
0
Mexico side
U.S. side, Hispanics
Source: Diaz-Apodaca BA, Rev Panam Salud Publica, 2010
U.S. side, Whites
IFG = Fasting Plasma
Glucose ≥ 126 mg/dL
Prevalence of type 1 (T1) and type 2 (T2)
diabetes among US youth, 2006
10−19 years
0−9 years
White
Black
Asian/Pac. Isl.
Am. Ind./Al. N.
Hispanic
Prevalence (%)
1
0.8
0.6
0.4
3.5
3
Prevalence (%)
1.2
2.5
2
1.5
1
0.2
0.5
0
T1
T2
0
T1
Source: SEARCH Study Group, Pediatrics, 2006
T2
Mexicans have a 60% higher prevalence of
gestational diabetes than whites
Age-Adj. Prevalence (%)
10
8
Age-adjusted prevalence of gestational diabetes, by
race/ethnicity and country of birth: Kaiser-Permanente, Northern
CA, 1995-2004
8
Outside U.S.
7
U.S.
6
6
5
5
4
5
4
4
Black
White
2
0
Mexican
Other Hispanic
CDC diabetes prevention
activities for Hispanics
•
Mobilize Communities to Reduce Diabetes: 5-year
cooperative agreement with National Alliance for
Hispanic Health (the Alliance)
•
•
Focus on Phoenix, AZ; Rio Rancho, NM, Watsonville, CA
National Diabetes Education Program
•
Focus on Hispanics and other at-risk groups
Affordable Care Act (ACA)
•
Funds prevention at sustainable level
•
Lowers barriers to preventive care by eliminating
cost-sharing for critical services
•
HHS is working with state and local partners and
dispersing grant assistance to ensure that
Americans get needed care
•
ACA investments in public health workforce will
benefit our communities for decades
ACA reduces health disparities by
improving access to health care
•
Preventive care: Medicare and some insurance
plans cover recommended preventive services
•
Coordinated care: Make investments in
community health teams to manage chronic
diseases
•
Diversity and cultural competency: Increase
racial and ethnic diversity in health care
professions
ACA reduces health disparities by
improving access to health care
•
Health care providers for underserved
communities: Expand health care workforce
and increase funding for community health
centers
•
End insurance discrimination: People who
have been sick can’t be excluded from coverage
or charged higher premiums
•
Affordable insurance coverage: Health
insurance exchanges will offer one-stop
shopping for individuals in the market for
insurance
ACA national prevention
strategy framework
•
Goal (draft): Increase the
number of Americans who
live to 85 in good health
•
Strategy focus (draft)
•
Healthy communities
•
Preventive clinical and
community efforts
•
Empowered individuals
•
Eliminating health disparities
CDC investment in
ACA in Prevention of
Public Health Funds:
$752M
National Prevention Strategy
recommendations (draft)
•
Standardize and collect health data for diverse
groups to identify and address disparities
•
Expand community collaboration to plan and
implement prevention policies and programs
•
Ensure that prevention strategies are culturally,
linguistically, and age appropriate
•
Reduce community and cultural barriers to
accessing clinical preventive services,
especially among populations at greatest risk
Prevention and Public Health Fund
•
•
$145M to community transformation grants in 2011
to implement, evaluate, and disseminate evidencebased community preventive health activities to
•
Reduce chronic disease rates
•
Prevent development of secondary conditions,
•
Address health disparities
•
Develop a stronger evidence-base of effective prevention
programming
$25M to Racial and Ethnic Approaches to
Community Health (REACH)
REACH
•
CDC effort to eliminate racial and ethnic health
disparities in U.S.
•
Hispanics targeted through 6 grantees:
•
University of Illinois at Chicago
•
Hidalgo Medical Services, Silver City, NM
•
Greater Lawrence Family Health Center, Lawrence, MA
•
ABOR University of Arizona, Tucson, AZ
•
YMCA of Santa Clara Valley, San Jose, CA
•
Health Visions Midwest, Hammond, IN
Our goal
• Improve health of all
populations and
eliminate health
disparities
• Ensure that Hispanic
communities receive
public health services
that keep them safe and
healthy