HTHRHSC 4400 Exam 1

Mortality Rate

(number of deaths/number of people in population at midyear) X 100

Strategies and solutions for overcoming barriers

- Expand healthcare coverage: Implement policies to increase access to health insurance coverage, such as expanding Medicaid eligibility and subsidizing insurance premiums for low-income individuals. - Improve healthcare infrastructure: Invest in the development of healthcare facilities, clinics, and telemedicine services, particularly in underserved rural and urban areas. - Increase healthcare workforce: Expand training programs, incentives, and loan forgiveness programs to recruit and retain healthcare professionals, including physicians, nurses, and allied health providers, in underserved communities. - Implement policies and programs to address social determinants of health, such as poverty, food insecurity, housing instability, and environmental hazards. - Integrate social services with healthcare delivery through collaborative models, such as accountable care organizations (ACOs) and medical-legal partnerships, to address patients' non-medical needs and improve health outcomes. - Advocate for policies that promote equitable access to education, employment, affordable housing, transportation, and nutritious food options to address upstream determinants of health.

What factors contribute to cancer disparities in the U.S.?

- racism, discrimination, segregation - structural inequities and societal injustices - adverse differences in social determinants of health - disparities in cancer care continuum and lack of diversity in workforce - adverse health outcomes

Include examples of 'why' for each group

1. African American individuals have higher rates of certain cancers, such as prostate cancer and breast cancer, and experience disparities in cancer screening, diagnosis, treatment, and survival compared to white individuals. Factors contributing to these disparities include socioeconomic factors, access to healthcare, cultural beliefs, and systemic racism within the healthcare system. 2. Individuals with low socioeconomic status often face barriers to accessing preventive care, cancer screening services, and timely treatment due to financial constraints, lack of health insurance, transportation issues, and limited health literacy. These barriers can result in later-stage cancer diagnoses and poorer treatment outcomes. 3. Uninsured individuals are less likely to receive recommended cancer screenings and may delay seeking medical care due to concerns about healthcare costs. Without health insurance coverage, they may also face financial burdens associated with cancer treatment, leading to disparities in access to quality care and health outcomes 4. Individuals living in rural areas may have limited access to cancer screening facilities, oncology specialists, and comprehensive cancer care services. Geographic barriers, transportation challenges, and workforce shortages contribute to disparities in cancer prevention, diagnosis, and treatment in rural communities. 5. LGBTQ+ individuals may face discrimination, stigma, and lack of culturally competent care when seeking cancer screening and treatment services. Fear of discrimination or negative experiences with healthcare providers can deter individuals from accessing care, leading to disparities in cancer prevention, detection, and treatment outcomes.

Health professionals do not reflect the diversity of our nation. Why is this problematic?

1. Cultural Competence: Diversity among health professionals ensures that patients from various cultural backgrounds feel understood, respected, and valued. Healthcare providers who share similar cultural backgrounds or identities with their patients may possess a deeper understanding of their cultural norms, beliefs, and healthcare practices. 2. Access to Care: Patients from marginalized or underserved communities often face barriers to accessing healthcare services. A lack of diversity among health professionals can contribute to mistrust and reluctance to seek care among these populations. 3. Health Disparities: Health disparities disproportionately affect minority and marginalized communities. These disparities are influenced by various factors, including socioeconomic status, race, ethnicity, language, and access to healthcare. By increasing diversity among health professionals, particularly in leadership and decision-making roles, healthcare organizations can better address the underlying causes of health disparities and implement strategies to reduce inequities in healthcare access, quality, and outcomes.

Which groups experience cancer health disparities?

1. Individuals belonging to a different ancestry, race, or ethnicity, 2. Individuals of low socioeconomic status 3. individuals who lack or have limited health insurance coverage 4. Residents in certain US geographic locations, such as rural areas, or territories, such as Puerto Rico 5. Members of the sexual and gender minority communities (LGBTQ+) 6. Certain immigrants, refugees, or asylum seekers 7. Individuals with disabilities 8. adolescents and young adults 9. elderly

Access - 5A's

1.Availability- are there services in the first place? 2.Adequacy- are these services enough? 3.Accessibility- can you get there? Will you be treated? 4.Affordability- can you pay? 5.Appropriateness- does it meet the needs of different groups?

What are the trends in insurance access for 0 - 64 years of age for 2019 and 2020?

2019 Trends: In 2019, the uninsured rate in the United States continued to decline. This trend had been ongoing since the implementation of the Affordable Care Act (ACA) in 2010. Medicaid expansion under the ACA contributed to increased insurance coverage among low-income adults in states that expanded Medicaid eligibility criteria. The individual mandate, which required most individuals to have health insurance coverage or face a penalty, remained in effect in 2019, encouraging more people to enroll in health insurance plans. 2020 Trends: The COVID-19 pandemic significantly impacted healthcare and insurance access trends in 2020. Millions of people lost their jobs due to pandemic-related layoffs and business closures, leading to a surge in unemployment. Many individuals who lost their jobs also lost employer-sponsored health insurance coverage, resulting in a spike in the number of uninsured individuals. Some people may have enrolled in Medicaid or marketplace plans due to special enrollment periods or changes in income eligibility criteria resulting from the pandemic. Economic uncertainty and fear of contracting COVID-19 may have influenced individuals' decisions regarding healthcare coverage and utilization.

Include examples of 'why' for each group contin.

6. Immigrants, refugees, and asylum seekers may encounter language barriers, immigration status concerns, lack of health insurance, and fear of deportation when accessing cancer care services. Limited access to culturally and linguistically appropriate care can contribute to disparities in cancer screening, diagnosis, and treatment among immigrant populations. 7. Individuals with disabilities may face challenges accessing cancer screening services due to physical accessibility issues, communication barriers, and lack of accommodations in healthcare facilities. Health promotion programs and cancer screening initiatives often overlook the unique needs and preferences of individuals with disabilities, leading to disparities in cancer prevention and early detection. 8. Adolescents and young adults may be less likely to receive recommended cancer screenings and may delay seeking medical care due to a lack of awareness about cancer risks, limited access to healthcare services tailored to their age group, and competing priorities such as school, work, and social activities. Delays in cancer diagnosis and treatment can result in poorer outcomes for this population. 9. Elderly individuals may have multiple chronic conditions, functional limitations, and cognitive impairments that complicate cancer diagnosis, treatment decision-making, and adherence to treatment regimens. Age-related factors, such as frailty, comorbidities, and decreased physiological reserve, can impact treatment tolerability and survival outcomes among older adults with cancer.

What benefits does Nathan tout as contributors to his success as a high school student?

A supportive family environment: Nathan emphasizes the importance of having a supportive family environment that encourages and values education. He acknowledges his parents' involvement in his education and their emphasis on the importance of hard work and dedication. Access to educational resources: Nathan mentions having access to educational resources, including books, technology, and academic support programs, which helped him excel academically. Engagement in extracurricular activities: Nathan highlights his involvement in extracurricular activities such as debate, which provided him with opportunities to develop leadership skills, critical thinking abilities, and communication proficiency. High expectations and accountability: Nathan attributes his success to the high expectations set by his teachers, mentors, and peers. He emphasizes the importance of accountability and striving for excellence in all endeavors. A growth mindset: Nathan emphasizes the value of having a growth mindset, which involves embracing challenges, persisting in the face of setbacks, and seeking opportunities for learning and personal growth.

What are crude and age adjusted death rates and what are differences between the two measures?

Crude Death Rate: The crude death rate is a simple calculation that expresses the number of deaths occurring in a population over a specific period (usually one year) per 1,000 or 100,000 population. It provides a basic overview of mortality within a population without considering differences in age distributions. Age-Adjusted Death Rate: The age-adjusted death rate is a statistical method used to compare mortality rates between populations or over time while accounting for differences in age distributions. It adjusts for the effects of age by standardizing the mortality rate to a reference population, which allows for a more accurate comparison of mortality rates across different populations or time periods. Differences between Crude and Age-Adjusted Death Rates: The main difference between crude and age-adjusted death rates lies in how they account for differences in age distributions within populations. Crude death rates provide a simple measure of mortality within a population but may be influenced by differences in age structures between populations. Age-adjusted death rates standardize mortality rates to a reference population, allowing for more accurate comparisons of mortality rates between populations or over time by controlling for differences in age distributions.

Why do underrepresented individuals experience lower quality of healthcare vs non-minorities?

Due to = Stereotyping, biases, provider uncertainty 1. Implicit Bias: Healthcare providers may hold unconscious biases and stereotypes about certain racial, ethnic, or cultural groups, which can influence their clinical decision-making, communication with patients, and treatment recommendations. 2. Socioeconomic Factors: Underrepresented individuals are more likely to experience socioeconomic disadvantages, such as lower income, limited access to education, unstable housing, and inadequate health insurance coverage. 3. Barriers: Underrepresented individuals may face barriers to accessing healthcare services, including geographic barriers (lack of transportation or proximity to healthcare facilities), financial barriers (cost of care, lack of health insurance), and cultural barriers (language barriers, lack of culturally competent care). 4. Historical and Structural Racism: contributed to persistent inequalities in healthcare access, quality, and outcomes for underrepresented individuals

Understand differences between equality and equity with an example

Equality: Equality refers to treating everyone the same regardless of their individual needs or circumstances. In healthcare, equality would mean providing the same level of care, services, and resources to all individuals regardless of their specific health needs or socioeconomic status. While equality promotes fairness, it may not address existing disparities or ensure that everyone has equal access to healthcare services. VS. Equity: Equity, on the other hand, involves recognizing and addressing the diverse needs of individuals to ensure that everyone has the opportunity to achieve the same level of health outcomes. It involves distributing resources and opportunities according to individual needs, which may vary based on factors such as income, education, geographic location, and existing health conditions. Equity in healthcare aims to level the playing field by providing additional support and resources to those who need it most, in order to achieve health outcomes that are equitable across different population groups.

We are products of our environment. How do these components impact success?

Family Environment: The family environment, including familial relationships, parenting styles, and household dynamics, significantly influences our values, aspirations, and work ethic. Educational Environment: Access to quality education, supportive teachers, rigorous academic programs, and enriching extracurricular activities can significantly impact academic success and skill development. Social Environment: Social interactions, peer relationships, and community networks shape our social skills, communication abilities, and interpersonal connections. Cultural Environment: Cultural norms, traditions, and values influence our identity, worldview, and sense of belonging within society. Economic Environment: Economic conditions, income inequality, and access to economic opportunities profoundly impact individuals' socioeconomic status, financial stability, and economic mobility. Physical Environment: The physical environment, including neighborhood conditions, access to healthcare, transportation, and recreational facilities, influences our health, well-being, and quality of life.

How do we collect data for health comparisons and what types of data is collected?

Health records survey - Misses people who do not seek medical treatment - Don't seek treatment due to cost? Due to other issues? Fear? Denial? Culturally inappropriate care? NHANES: Collects information & performs physical examinations on nationally representative sample Information on diagnosed disease AND undetected disease NHIS: a randomly selected adult and randomly selected child under 18; How do people FEEL about their health? Family core and child core portions Health conditions, health-related behaviors, health-seeking experiences, health care coverage; Allows us to look at access and utilization

What is the advantage to de-aggregating data?

Identification of Patterns and Trends: De-aggregating data allows analysts to identify patterns, trends, and relationships that may be obscured when data is aggregated Granular Analysis: De-aggregating data enables analysts to conduct more granular analysis and explore variations across different dimensions, such as time, geography, demographics, or other categorical variables. Detection of Disparities and Inequities: De-aggregating data can help identify disparities, inequities, and disparities that may exist within the population or across different subgroups. Enhanced Transparency and Accountability: De-aggregating data promotes transparency and accountability by providing stakeholders with access to detailed information about the underlying data and analysis methods.

Example

Imagine a community with a high prevalence of diabetes. In a healthcare system that emphasizes equality, everyone would receive the same standard of care for diabetes management, such as access to medications and educational materials, regardless of individual circumstances. However, in a healthcare system that prioritizes equity, resources would be allocated based on the specific needs of the population. For instance, individuals with low income who may struggle to afford medications or access healthy food options could receive additional support, such as subsidies for medication costs or nutrition counseling services. Additionally, efforts might be made to increase access to healthcare services in underserved areas within the community, ensuring that everyone has equal opportunity to receive care. In summary, while equality aims to treat everyone the same, equity recognizes that different individuals have different needs and seeks to address disparities in order to achieve fair and just health outcomes for all.

Who experiences the highest rates of diabetes and why?

Minority and Ethnic Groups: African American, Hispanic/Latino, Native American, Asian American, and Pacific Islander communities have higher rates of diabetes compared to non-Hispanic white individuals. Low Socioeconomic Status (SES) Populations: Individuals with lower socioeconomic status, including those with lower income levels, lower levels of education, and limited access to healthcare resources, are more likely to develop diabetes. Certain Geographic Regions: Some geographic regions, particularly areas with higher rates of poverty, limited access to healthy foods, and fewer opportunities for physical activity, have higher prevalence rates of diabetes.

How can you use the lessons from this TED talk to improve/reduce disparities in health care? Provide specific examples

Promoting Cultural Competence: Healthcare providers can learn to appreciate the diversity of patients' backgrounds, cultures, and experiences. Addressing Stereotypes and Biases: Healthcare providers should actively work to identify and challenge stereotypes and biases that may influence their clinical decision-making, communication with patients, and treatment recommendations. Ensuring Representation and Inclusion: Healthcare organizations should strive to ensure that their workforce reflects the diversity of the communities they serve. Listening to Patient Narratives: Healthcare providers should prioritize listening to patients' narratives, experiences, and perspectives. Advocating for Structural Changes: Healthcare professionals can advocate for structural changes within the healthcare system and broader society to address the root causes of health disparities, including poverty, discrimination, and unequal access to resources and opportunities.

Social determinants of health

Social determinants of health are the conditions in which people are born, grow, live, work, and age, as well as the wider set of forces and systems shaping the conditions of daily life. These determinants influence health outcomes, quality of life, and health disparities. 1. Economic Stability 2. Education 3. Social and Community Context 4. Physical Environment 5. Healthcare Access 6. Health Behaviors

Explain the impact on overall health of social determinants of health

Social determinants of health encompass the social, economic, and environmental conditions in which people are born, grow, live, work, and age. These factors significantly influence individuals' health outcomes, access to healthcare services, and overall well-being.

Medicaid Expansion

Some states have expanded their Medicaid programs to cover all people with household incomes below a certain level. Whether you qualify for Medicaid coverage depends partly on whether your state has expanded its program.

Describe the developmental origin of health and disease.

The developmental origin of health and disease (DOHaD) is a concept that emphasizes the critical role of early life experiences and environmental exposures in shaping long-term health outcomes and susceptibility to disease later in life. This theory suggests that factors occurring during critical periods of development, including prenatal, early childhood, and adolescence, can have lasting effects on an individual's health trajectory and risk of developing chronic diseases in adulthood.

Prevalence

The number or proportion of cases of a particular disease or condition present in a population at a given time. the number of cases that exist in the population

What is the danger with a single story?

The risk of the single story, the one perspective, is that it can lead us to default assumptions, conclusions and decisions that may be incomplete, and may lead to misunderstanding. Operating from the context of a single story can prevent us from a more complex, nuanced view of a situation.

Health Equity

When all people are given the chance to live as healthy a life as possible regardless of their race, ethnicity, sex, gender identity, sexual orientation, disability, education, job, religion, language, where they live, or other factors. (AACR), The state in which everyone has a fair and just opportunity to attain their highest level of health. (CDC)

Equity

a condition in which people receive from a relationship in proportion to what they give to it

Mortality

death

Medicaid

free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

Stress Model

general feelings of well-being; which can be determined only by an individual's own view of the situation. This determines whether the person is experiencing sufficient stress to produce detrimental health effects

Specific components of social determinants of health

healthcare access and quality, education access and quality, social and community context, economic stability, and neighborhood and built environment.

Morbidity

illness

Incidence

number of cases

Equality

the state of being equal, especially in status, rights, and opportunities.

Medical Model

•: focus on the absence of disease; views disability as resulting from an individual person's physical or mental limitations, and is not connected to the social or geographical environments. The Medical Model focuses on finding a "cure" or making a person more "normal." •Must be observable, objective signs of disease •Only physicians or other advanced providers can diagnose disease •Health is solely physiological •It is appropriate to focus on non-health as opposed to health

Accessibility

•: the design, construction, development, and maintenance of facilities, information and communication technology, programs and services, so that all people, including people with disabilities, can fully and independently use them (Dept. of Labor)

Monogenic

•Caused by a mutation in a single gene •Relatively rare •Ex: sickle cell disease, cystic fibrosis, Tay-Sachs, polycystic kidney disease

Multifactorial inheritance disorder

•Combination of small inherited genetic variations Ex: most diseases where genetics plays a role- heart disease, diabetes, cancers, etc.

Define disparities.

•Differences in health and healthcare between groups that stem from broader inequities (KFF) •A particular health difference linked with social, economic, and/or environmental disadvantage that adversely affects groups of people who have systematically experienced greater obstacles to health (HP2030) (Social determinants of health) •Preventable differences in the burden, disease, injury, violence, or in opportunities to achieve optimal health experienced by socially disadvantaged racial, ethnic, and other population groups and communities (CDC)

genetics and obseity

•Excess weight is related to calories in vs. calories out •Role of environment & behaviors •Environmental exposures interacting with genes •Epigenetics •Developmental Origin of Health and Disease (DOHaD) (Studies suggest that harmful exposures that occur early in life, while tissues and organs are developing, may increase the risk of disease later in life. Sometimes these risks carry over into future generations. This concept is called the developmental origins of health and disease, or DOHaD.)

Chromosomal

•Excess/deficiency in # of chromosomes or genes located on chromosomes •Ex: Trisomy 21; translocation error (some leukemias)

Why study disparities?

•Major agencies have recognized the importance (ex. WHO, CDC, HHS) •To address, you must study •Provide culturally and linguistically appropriate care •Reduce barriers to attaining and maintaining health

Describe the relationship between race and genetics.

•Race does NOT have a basis in genetics •Frequency of gene mutations differs between populations •Often based on common ancestry - NOT the same as race/ethnicity - while there are genetic differences between populations, race is a socially constructed concept that does not fully capture the complexity of human genetic diversity. Understanding the relationship between race and genetics requires recognizing the limitations of racial categorization and acknowledging the diverse and interconnected nature of human populations.

Sociocultural Model

•focus on capacity to function socially •Patient perspective is at the center •Social performance and functioning are primary importance •Health is relative depending on one's role and its requirements •Nonperformance of one's role is deviant and therefore socially sanctioned