5. Disparities and Inequities

Disparities may be assessed based on what types of characteristics of people/populations?

race ethnicity socioeconomic status (poverty, wealth, education, "position") gender language spoken nationality/immigrant status age sexual orientation/identity gender identity disability

What's an example of this?

African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb

What are some types of measures of disparities (quality, access, outcomes)? ~lindsay said this question is really broad and a number of answers would work for this~

ER wait times higher infant mortality rates among blacks different access rates --- like number of visits to specialists among groups

What are some health insurance disparities?

different races have different uninsurance rates ex. hispanics are 17.3% of population but have 30% uninsurance rate while whites are 60% of the population and have a 11.1% uninsurance rate

Why is health equity important?

health equity is vital for achieving social equity

What was the Tuskegee Syphilis Trial and how did it impact many African Americans' perception of healthcare in America?

The trial consisted of untreated cases of syphilis in African Americans who were under the misconception that they were receiving free health care when in reality, the progression of the disease was being studied. African Americans' perception of healthcare in America: distrust that led many to forgo treatment of curable illnesses (ex. HIV/AIDS treatment)

What is meant by understanding race as a social construct rather than a biological fact and how is that distinction relevant for healthcare practice?

There are no biologically-distinct races or ethnicities; race is perceived differently by different people depending on what they are there are no "sub species" of humans It's important because people of color experience differential treatment, based on stereotypes, instead of evidence-based medicine which should be applied regardless of race AND it's important that SINCE there is differential treatment, we need to keep track of this and be aware of fixing it.

What are some examples of healthcare disparities?

access to private insurance, differential quality outcomes or quality of care, availability of facilities they can access (i.e. less private practices in low SES neighborhoods) ex. different number of eye exams between races ex. rates of colonoscopies between races

How can implicit bias and stereotypes impact healthcare?

bias and stereotypes occur because of time pressure can result in providers' and patients' mistrust which leads to poor quality care and worse health outcomes lack of treatment, inferior treatment, overly aggressive treatment

What are some examples of how the ACA will reduce healthcare disparities?

expanding access to insurance (Medicaid/exchanges) expanding access to quality care through community health center investment tracking healthcare along with race, ethnicity, primary language, geographic area, and disability healthcare workforce development will provide job/training opportunities and more providers in underserved areas permanent support for the health promotion and care through the Indian Healthcare Improvement Act

What's a healthcare disparity getting worse and one getting better?

getting worse- maternal deaths per 100,000 live births in Blacks compared to Whites getting better- hospital admissions for congestive heart failure per 100,000 population in Blacks and Hispanics compared to Whites

What's the difference between health and healthcare disparities? And disparities and inequities?

health disparities vs healthcare disparities-- healthcare disparities contribute to health disparities (differences in quality and access to care result in a particular group experiencing larger burden of illness) disparity vs inequity-- health inequity is unfair and unjust that root from social injustices and systemic problems while health disparity is only the difference in health outcomes between population groups

What are the definitions of Health disparities, Healthcare disparities, Health inequity, Health equity?

health disparities= higher burden of illness, injury, disability, or mortality experienced by one population group relative to another group healthcare disparities= differences between groups in health coverage, access to care, and quality of care health inequity=unjust, unnatural, and avoidable differences in health status, in the distribution of disease and illness, and in mortality rates across population groups; systemic problems health equity= increasing fairness and reducing the negative effect of disadvantaged group membership on health

What are some other suggestions for reducing healthcare disparities?

increase quality for everyone increase uniform use of evidence-based treatment guidelines control biases: recognize and acknowledge potential for bias and impact on care ask questions rather than make assumptions think of what you share, including commitment to health self-regulation of bias -- quality control; train an instinct for respect

What are some factors that contribute to healthcare disparities?

insurance status patient socioeconomic status patient co-morbid conditions racial differences in disease severity or stage of illness at presentation patients' appropriateness for procedures rates of refusal or patient preferences

What's the main finding of the IOM's Unequal Treatment?

minorities (esp. Blacks) are treated differently they have worse outcomes attributable to healthcare experience

Why is there "unequal treatment"?

patient "preference" to be treated differently systemic bias in society gets reproduced in healthcare racism among providers: stereotypes, disrespect, prejudice, bigotry, ignorance

What are the dangers of "racial profiling" in medical practice?

racial profiling leads to mistakes that can arise since self-identified race says nothing about risk, history, or treatment of an individual it results in stereotyping not cultural competency