Health Disparities From knowledge to action Overview of Disparities Ethnicity Geographic location Socioeconomic Status.
Download ReportTranscript Health Disparities From knowledge to action Overview of Disparities Ethnicity Geographic location Socioeconomic Status.
Health Disparities From knowledge to action Overview of Disparities Ethnicity Geographic location Socioeconomic Status Overview of Disparities Minority Americans report widespread patient-physician communication differences Minority Americans are more likely to feel treated with disrespect when obtaining health care Though the gap is closing disparities persist in satisfaction with primary and secondary care Overview of Disparities From : Unequal Treatment; Confronting Racial and Ethnic Disparities in Health care – IOM 2003 Overview of Disparities Minority Americans have worse health status and more chronic conditions Minority Americans have lower rates of insurances coverage and less access to care Overview of Disparities Disparities are found across a range of clinical settings, including public and private hospitals, teaching and non-teaching hospitals, etc. Disparities in care are associated with higher mortality among minorities (e.g., Bach et al., 1999; Peterson et al., 1997; Bennett et al., 1995) Overview of Disparities Disparities consistently found across a wide range of disease areas and clinical services Disparities are found even when clinical factors, such as stage of disease presentation, co-morbidities, age, and severity of disease are taken into account Potential sources of healthcare disparities Health systems-level factors – financing, structure of care; cultural and linguistic barriers. Patient-level factors – including patient preferences, refusal of treatment, poor adherence, biological differences. Disparities arising from the clinical encounter. Causes of Death (2000) USA Rank White African American Hispanic 1 2 Cardiovascular Cardiovascular Cardiovascular Cancer Cancer Cancer 3 4 5 Cerebrovascular Cerebrovascular Unintentional Injury COPD Unintentional Injury Cerebrovascular Unintentional injury Diabetes Diabetes 6 7 Pneumonia Homicide Chronic liver disease Diabetes HIV/AIDS Homicide Mortality Rates* (All causes) 2000 All White African American Asian American Hispanic US 870.4 849.8 1126.6 516.5 670.1 Southern US 884.7 838.7 1138.4 435.3 603.5 Georgia 965.7 915.3 1148.6 530.8 441.6 From National Center for Health Statistics * - rates reported per 100,000 individuals Cardiovascular/Cerebrovascular Leading cause of death in African American men (33.5%) and women (40.6%) More than twice as likely to die from hypertensive heart disease Prevalence of high blood pressure one of the highest in the world ( worse in the southeastern US) 45% have blood cholesterol levels of > 200 mg/dl 36%of African Americans have hypertension African Americans at greater risk than whites for death from both Two to three times greater risk to have an ischemic stroke Higher death rates from stroke Americans Diabetes 2.7 million or 11.4% of all African Americans more than twenty years old have DM. African Americans and Hispanics are twice as likely to have DM than non-Hispanic whites. There is twice the risk of developing heart disease and stroke. 2 to 4 times the risk of dying from heart disease. One in every four African American women over 55 years has DM. HIV/AIDS Problem of EPIDEMIC proportion. African Americans accounted for half of the new cases in 2001. More than 168,000 African Americans died of AIDS in 2001. Leading cause of death in African American men aged 35-44. Approximately 78% of HIV infected women are minorities. African-American and Hispanic children accounted for more than 80% of pediatric AIDS cases in 2000. Aids Infection by Gender and Race Females Males African American Whites 17% 20% 43% 64% 17% Latino Other 35% Cancer Death Rates, by Race and Ethnicity, 1996-2000 400 Men 356.2 Women 350 300 249.5 250 200 198.6 166.9 176.7 172.3 154.8 150 102.0 115.8 112.4 100 50 0 White African American Asian/Pacific Islander American Indian/ Alaskan Native Hispanic† *Per 100,000, age-adjusted to the 2000 US standard population. † Hispanic is not mutually exclusive from whites, African Americans, Asian/Pacific Islanders, and American Indians. Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003. Cancer Sites in Which African-American Death Rates Exceed White Death Rates for Men, US, 1996-2000 Site •All sites •Larynx •Prostate •Stomach •Myeloma •Oral cavity and pharynx •Esophagus •Liver •Lung & bronchus •Pancreas •Small intestine •Colon & rectum African American 356.2 5.7 73.0 14.0 9.2 7.9 12.2 9.3 107.0 16.4 0.7 34.6 White 249.5 2.4 30.2 6.1 4.5 4.0 7.3 6.0 78.1 12.0 0.5 25.3 Ratio of African American/White 1.4 2.4 2.4 2.3 2.0 2.0 1.7 1.6 1.4 1.4 1.4 1.4 *Per 100,000, age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003. Cancer Survival*(%) by Site and Race,1992-1999 Site White African % Difference American All Sites 64 53 11 Breast (female) 88 74 14 Colon & rectum 63 53 10 Esophagus 15 9 6 Leukemia 48 39 9 Non-Hodgkin lymphoma 57 47 10 Oral cavity 60 36 24 Prostate 99 93 6 Urinary bladder 83 64 19 Uterine cervix 73 61 12 Uterine corpus 86 60 26 *5-year relative survival rates based on cancer patients diagnosed from 1992 to 1999 and followed through 2000. Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003. Causes of Death in African Americans (2000) - Georgia 5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0 Cancer Cardiovascular Stroke Diabetes HIV/AIDS Homicide Unintentional Injury Health Status in Georgia 2001 1999 Dade Dade Dade Dade Dade Dade Catoosa Catoosa Catoosa Catoosa Towns Towns Towns Towns Towns Towns Fannin Fannin Union Union White White White White Gilmer Gilmer Walker Walker Walker Habersham Habersham Stephens Stephens Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Gordon Gordon Chattooga Chattooga Chattooga Pickens Pickens Pickens Dawson Dawson Banks Banks Hall Hall Floyd Floyd Floyd Bartow Bartow Franklin Franklin Franklin Franklin Polk Polk Polk Barrow Barrow Madison Madison Madison Madison Madison Madison Gwinnett Gwinnett Cobb Cobb Clarke Clarke Douglas Douglas Fulton Fulton Fulton Troup Troup Pike Pike Meriwether Meriwether Meriwether Dawson Dawson Dawson Dawson Lincoln Lincoln Taliaferro Taliaferro Greene Greene Greene Jasper Jasper Jasper Lamar Lamar Lamar Lamar Monroe Monroe Douglas Douglas Fulton Fulton Fulton Washington Washington Bibb Bibb Bibb Bibb Bibb Bibb Taylor Taylor Pike Pike Meriwether Meriwether Meriwether Pulaski Pulaski Dodge Dodge Dodge Calhoun Calhoun Calhoun Lee Lee Lee Lee Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty Effingham Effingham Effingham Effingham Effingham Effingham Richmond Richmond Glascock Glascock Baldwin Baldwin Jones Jones Washington Washington Burke Burke Burke Burke Burke Burke Jefferson Jefferson Jefferson Ben Ben Hill Hill Jeff Jeff Davis Davis Dooly Dooly Dooly Irwin Irwin Worth Worth Coffee Coffee Bacon Bacon Wayne Wayne Berrien Berrien Mitchell Mitchell Colquitt Colquitt Colquitt Colquitt Cook Cook Ware Ware Brantley Brantley Clinch Clinch Thomas Thomas Thomas Thomas Ben Ben Hill Hill Turner Turner Turner Turner Turner Turner Coffee Coffee Long Long Long Appling Appling Bacon Bacon Wayne Wayne McIntosh McIntosh Pierce Pierce Berrien Berrien Mitchell Mitchell Colquitt Colquitt Colquitt Colquitt Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson Cook Cook Ware Ware Brantley Brantley Glynn Glynn Glynn Lanier Lanier Lanier Lanier Lanier Lanier Clinch Clinch Camden Camden Decatur Decatur Decatur Decatur Decatur Decatur Grady Grady Grady Grady Grady Grady Thomas Thomas Thomas Thomas Brooks Brooks Lowndes Lowndes Echols Echols Chatham Chatham Chatham Tift Tift Tift Seminole Seminole Seminole Seminole Seminole Seminole Charlton Charlton Jeff Jeff Davis Davis Irwin Irwin Worth Worth Glynn Glynn Glynn Miller Miller Bryan Bryan Bryan Bryan Tattnall Tattnall Telfair Telfair Telfair Liberty Liberty Lee Lee Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty Effingham Effingham Effingham Effingham Effingham Effingham Evans Evans Evans Evans Toombs Toombs Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler Baker Baker Baker Baker Brooks Brooks Lowndes Lowndes Terrell Terrell Calhoun Calhoun Calhoun Atkinson Atkinson Atkinson Lanier Lanier Lanier Lanier Lanier Lanier Grady Grady Grady Randolph Randolph Early Early Pierce Pierce Dodge Dodge Dodge Crisp Crisp McIntosh McIntosh Tift Tift Tift Pulaski Pulaski Bulloch Bulloch Candler Candler Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery Wilcox Wilcox Clay Clay Clay Clay Clay Clay Treutlen Treutlen Treutlen Sumter Sumter Sumter Sumter Sumter Sumter Chatham Chatham Chatham Long Long Long Appling Appling Laurens Laurens Macon Macon Webster Webster Webster Screven Screven Emanuel Emanuel Bleckley Bleckley Bleckley Bleckley Quitman Quitman Turner Turner Turner Turner Turner Turner Jenkins Jenkins Johnson Johnson Twiggs Twiggs Twiggs Peach Peach Houston Houston Marion Marion Marion Marion Chattahoochee Chattahoochee Chattahoochee Stewart Stewart Stewart Bryan Bryan Tattnall Tattnall Wilkinson Wilkinson Crawford Crawford Evans Evans Evans Evans Liberty Liberty Seminole Seminole Seminole Seminole Seminole Seminole Decatur Decatur Decatur Monroe Monroe Schley Schley Toombs Toombs Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler Baker Baker Miller Miller Lamar Lamar Lamar Lamar Taylor Taylor Bulloch Bulloch Candler Candler Telfair Telfair Telfair Crisp Crisp Early Early Columbia Columbia Columbia Columbia Warren Warren Putnam Putnam Hancock Hancock Hancock Talbot Talbot Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery Wilcox Wilcox Randolph Randolph Randolph Randolph Treutlen Treutlen Treutlen Sumter Sumter Sumter Quitman Quitman Harris Harris Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee Laurens Laurens Macon Macon Dooly Dooly Dooly Clay Clay Clay Clay Clay Clay Jasper Jasper Jasper Bibb Bibb Bibb Bibb Bibb Bibb Screven Screven Emanuel Emanuel Bleckley Bleckley Bleckley Bleckley Terrell Terrell Taliaferro Taliaferro Taliaferro Taliaferro Greene Greene Greene McDuffie McDuffie Butts Butts Butts Butts Butts Butts Spalding Spalding Spalding Spalding Spalding Spalding Troup Troup Jenkins Jenkins Peach Peach Houston Houston Marion Marion Marion Marion Webster Webster Webster Morgan Morgan Morgan Morgan Newton Newton Coweta Coweta Burke Burke Burke Burke Burke Burke Jefferson Jefferson Jefferson Lincoln Lincoln Wilkes Wilkes Rockdale Rockdale Fayette Fayette Fayette Richmond Richmond Johnson Johnson Twiggs Twiggs Twiggs Schley Schley Stewart Stewart Stewart Oglethorpe Oglethorpe Henry Henry Wilkinson Wilkinson Crawford Crawford Chattahoochee Chattahoochee Chattahoochee Clarke Clarke Upson Upson Talbot Talbot Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee Elbert Elbert Elbert Walton Walton Clayton Clayton Carroll Carroll Carroll Carroll Upson Upson Harris Harris Madison Madison Madison Madison Madison Madison Oconee Oconee DeKalb DeKalb DeKalb DeKalb Glascock Glascock Baldwin Baldwin Jones Jones Georgia Health Status Score: 37.8 Gwinnett Gwinnett Cobb Cobb Heard Heard Hancock Hancock Hancock Hart Hart Hart Hart Barrow Barrow Haralson Haralson Columbia Columbia Columbia Columbia Warren Warren Putnam Putnam Franklin Franklin Franklin Franklin Forsyth Forsyth Cherokee Cherokee McDuffie McDuffie Butts Butts Butts Butts Butts Butts Banks Banks Banks Banks Hall Hall Hall Hall Bartow Bartow Paulding Paulding Paulding Fayette Fayette Fayette Spalding Spalding Spalding Spalding Spalding Spalding Pickens Pickens Pickens Polk Polk Polk Polk Polk Polk Henry Henry Coweta Coweta Habersham Habersham Stephens Stephens Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Gordon Gordon Jackson Jackson Wilkes Wilkes Morgan Morgan White White Gilmer Gilmer Chattooga Chattooga Chattooga HealthStatus Status Health Excellent 58-100 Good 33-57 Fair 21-32 Poor 0-20 Rabun Rabun Rabun Rabun Union Union Walker Walker Walker Rockdale Rockdale Newton Newton Towns Towns Towns Towns Towns Towns Fannin Fannin Murray Murray Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield Oglethorpe Oglethorpe Oglethorpe Oglethorpe Walton Walton Clayton Clayton Heard Heard Catoosa Catoosa Catoosa Catoosa Elbert Elbert Elbert Oconee Oconee Oconee Oconee DeKalb DeKalb DeKalb DeKalb Dade Dade Dade Dade Dade Dade Floyd Floyd Floyd Georgia Health Status Score: 51.9 Paulding Paulding Paulding Carroll Carroll Hart Hart Forsyth Forsyth Cherokee Cherokee Jackson Jackson Haralson Haralson Health Status Excellent 67-100 Good 40-66 Fair 26-39 Poor 0-25 Rabun Rabun Rabun Rabun Murray Murray Whitfield Whitfield Whitfield Echols Echols Prepared by: G.E. Alan Dever, Ph.D., M.T., M.D. (Hon.), Leah Trawick, B.S., & Lucy Kemp Department of Community Medicine - Mercer University School of Medicine Prepared by: G.E. Alan Dever, Ph.D., M.T., M.D. (Hon.) & Leah Smith, M.P.H. Department of Community Medicine - Mercer University School of Medicine Data Source: Inforum, 2000 Data Source: Inforum, 2002 Charlton Charlton Charlton Charlton Camden Camden Disparities in Georgia Outcomes in Georgia Infant mortality rates in African Americans is more than twice that in Whites. Prostate Cancer death rates are > 50% higher in African Americans. African Americans are more than twice as likely to die from Hypertensive Heart Disease. Hispanics are twice as likely to die from Diabetes than whites. From: Georgia Division of Public Health; Vital Statistics 2001 Disparities in Georgia Coverage in Georgia More likely to use emergency room as main source of medical care. 4 to 5 times less likely to have had BP check in last 2yrs. 3 to 4 times less likely to have had a mammogram in last 2yrs. Children 2 times less likely to have seen a doctor in last 2 years. Uninsured by Ethnicity (2002) - GA. 6.8% 20.3% 11% 13.8% White African American Hispanic Other From : Georgia Healthcare Coverage Project ( Custer & Ketsche 2003) Uninsured by Ethnicity (2002) - USA 18.2%% 10.7% White African American 20.2% 32.4% Hispanic Asian Uninsured by race and income Other >300%FPL <300%FPL <200%FPL <FPL Hispanic AfricanAmerican White 0 10 20 30 40 From : Georgia Healthcare Coverage Project ( Custer & Ketsche 2003) I.O.M Report “In unassailable terms, the report found that even when their insurance and income are the same as those of whites, minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments, including heart disease, cancer, diabetes and HIV/AIDS. By stripping away the pretense that the differences can be explained by minorities' lack of access to timely care, the report should spur doctors and patients to question why racial disparities are tolerated in medicine.” USA Today, March 22 “Racial Bias in Health Care” I.O.M. Recommendations Policy & Regulatory Avoid fragmentation of health plans along socioeconomic lines. Strengthen the stability of patient-provider relationships in publicly funded health plans. Increase the proportion of under-represented US racial and ethnic minorities among health professionals. From : Unequal Treatment; Confronting Racial and Ethnic Disparities in Health care – IOM 2003 I.O.M. Recommendations Policy & Regulatory Apply the same managed care protections to publicly funded HMO enrollees that apply to private HMO enrollees. Provide greater resources for the DHHS Office for Civil Rights to enforce civil rights laws. From : Unequal treatment; Confronting Racial and Ethnic Disparities in Health care – IOM 2003 I.O.M. Recommendations Health Systems Promote the consistency and equity of care through use of evidence based guidelines. Structure payment systems to ensure adequate supply of services to minority patients and limit provider incentives that promote disparities. Enhance patient-provider communications and trust by providing financial incentives for practices that decrease barriers and encourage evidence based practices. From : Unequal treatment; Confronting Racial and Ethnic Disparities in Health care – IOM 2003 I.O.M. Recommendations Health System Support the use of interpretation services where community need exists. Support the use of community health workers Implement multi-disciplinary treatment and preventive care teams. From : Unequal treatment; Confronting Racial and Ethnic Disparities in Health care – IOM 2003 I.O.M. Recommendations Education Implement patient education programs to increase patient’s knowledge of how to best access care and participate in treatment decisions. Integrate cross cultural education into the training of all current and future health professionals. From : Unequal treatment; Confronting Racial and Ethnic Disparities in Health care – IOM 2003 Federal Action DHHS Initiative to Eliminate Racial and Ethnic Disparities in Health NIH Strategic Research Plan to Reduce and Ultimately Eliminate Health Disparities NLM Strategic Plan to Reduce Racial and Ethnic Disparities Healthy People 2010 100% access, Zero Disparities - BPHC Community Action Hispanic Health Care Outreach North West Georgia Healthcare Partnership Vision “Promotora” – Community health worker Improved access Focus on Men's Health Network of South-central counties Screening ( PSA, Cholesterol and BP) Early detection Knowledge is Key Action is Power