Disparities in Health Outcomes

Healthy People 2020

-most important pubic health document for the nation -sets public health agenda for the nation -provides science-based, ten year national objectives to improve the health of all Americans

lowest BMI is in which educational group?

College grad

stereotypes

process by which people use social categories (e.g., race, sex) in acquiring, processing, and recalling information about others.

relative difference

ratio or fraction that results by dividing one number by another

ACA Efforts to reduce disparities

-Expansion of health insurance coverage through both Medicaid and private coverage purchased through new state health insurance exchanges with the assistance of federal subsidies. -Expanding care that can be delivered through community health centers. -Diversifying the health care workforce and creating a larger pool of 'culturally competent' providers to treat racial and ethnic minorities. -All federally associated programs collect and report information on race, ethnicity, and language of patients and enrollees.

Recent trends to alleviate disparities

-Strengthening doctor-patient relationships -Employing community health workers often termed lay health advisors who fulfill multiple functions in helping to improve access to healthcare.

Disparity definition

-a difference, two quantities are not equal (inequality). Rate A ≠ Rate B.

Social and economic determinants of health disparities

-above/below the poverty line -education -geography and neighborhood -environment -stress -lower quality care -inadequate access to care -inability to navigate the system

Role of public health scientists

-can measure differences or disparities in health outcomes. -However, social and political discourse is required to assess which disparities are unjust and thus require priority policy attention.

Changes over time that impact efforts to monitor and measure health disparities

-demographics change, immigration changes, definitions of social group change (for example changes in racial/ethnic classification in the US Census from 1990 to 2000).

Efforts to reduce disparities

-focus on improving the overall health of the population and targeted efforts to improve the health of underserved populations in particular. (if you want to improve health by reducing heart attacks, then you should increase the number of Americans with good blood pressure) -To improve the quality of care health care systems provide to everybody, with particular attention to closing the gaps that affect minorities (if you want to improve the quality of care, then you should increase the screening rates for cholesterol and cancer)

Physician barriers with minority pts

Doctors reporting difficulty communicating with minority patients, not having enough time to spend with them, and patient nonadherence to recommended treatment.

Goals of Healthy People 2020

Goal 1: Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Goal 2: Achieve health equity, eliminate disparities, and improve the health of all groups. Goal 3: Create social and physical environments that promote good health for all. Goal 4: Promote quality of life, healthy development, and healthy behaviors across all life stages.

Measures of Progress for Goal 2 (Disparity and Equity Troubles)

Measures of disparities and inequity include differences in health status based on race/ethnicity, gender, socioeconomic status, disability status, sexual orientation, and geography.

Research on Prejudice/bias

Research suggests that healthcare providers' diagnostic and treatment decisions, as well as their feelings about patients, are influenced by patients' race or ethnicity.

Crossing the Quality Chasm: A New Health System for the 21st Century (2001).

The IOM highlights equity as one of the six key pillars to providing high-quality care and pointed to the lack of equity as one of the major deficiencies of the US health care system.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2003).

The report cited a consistent body of research that racial and ethnic minorities were more likely to experience lower-quality health care than whites.

Clinical Uncertainty

any degree of uncertainty a physician may have relative to the condition of patient.

Inequities

based on ethical judgments about differences (inequalities). -Is it fair that poor people die younger than rich people, smokers get more lung cancer than non-smokers?

Inequalities in health

based on observed differences or disparities in health, for example poor people die younger than rich people (compare death rates), smokers get more lung cancer than non-smokers.

healthcare provider qualities that lead to unequal treatment

clinical uncertainty, stereotyping, prejudice/bias

How do we know a health disparity exists?

data

Highest BMI is above which educational group?

less than eighth grade

absolute difference

subtraction from one number from another