Chapter 10: Community ad Public Health and Racial/Ethnic Populations

Definitions of Racial and Ethnic Minority Population

(monitoring and enforcement of civil rights) Race - Asian: people having origins to Far East, Southeast Asia, or Indian subcontinent - Black or AA: Africa - American Indian: North and South America (and central) and has tribal and community attachment - Pacific Islanders: Hawaii, Guam, Samoa, other Pacific islands - White: Europe, the Middle East, or North Africa Ethnicity - Hispanic or Latino: Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture

operationalize

(operational definition) provide working definitions

Transfer Act

- 1954. Public Law 83-568. - Responsibility of NA were transferred from the BIA to the US Public Health System which created the Indian Health Service (IHS) to carry out these responsibilities.

Indians Self-Determination and Education Assistance Act

- 1975. - Allowed the IHS to involve tribes in the administration and operation of programs under a special program. allowed the IHS to provide grants to tribes, on request, for planning, development, and operation of health programs

Race and Ethnic Standards for Federal Statistics and administrative reporting.

- 1978 - Published by the Office of Management and Budget of Directive 15 - Regulations used for statistical classification of racial and ethnic groups by federal agencies. - Presented brief rules for classifying persons into four racial categories (AI or Alaska Native, Asian or Pacific Islander, black, and white) and two ethnic groups (Hispanics and non Hispanics) - Meant to operationalize race and ethnicity and it provided the standards by which federal government agencies collected and classified racial and ethnic data in 1980s and 1990s

One America in the 21st Century: The President's Initiative on Race

- 1997 Clinton declared that the US will commit to the national goal of elimination racial and ethnic health disparities by the year 2020. - national effort was meant to enhance efforts in: preventing disease, promoting health, delivering care in racial and ethnic minority communities - one primary aim consists of consultation and collaboration among federal agencies: state local tribal governments and community professional to research and address issues that affect health outcomes

Asian Americans Overview and Leading Causes of Death

- 1999 Clinton signs the Executive order to improve quality of life of Asians and Pacific Islanders through increased participation in federal programs where they may be underserved and to collect separate data on each group. Not until 2010 decennial census is when data for these groups would be disaggregated. - People of Asian descent and root trace to more than 20 different Asian countries. - 6.3% of the population. Fastest growing population segment in 2012. Asian Concentrated in the western states, Northeast, and parts of the South and Native Hawaiian concentrated in the western mainland states and Hawaii. - Immigration important to Asian American community growth. Immigration has occurred at different times. - 86% of AA have HS diploma but rates range as high as 96% for Tawin and 615 for Hmong. - Concept of balance is related to health and imbalance is related to disease. Highly related to diet (influences daily activities). TO achieve health people must adjust to the environment in a holistic manner. Traditional healing methods vary. - NHOPI people from Hawaii, Guam, Samoa, other Pacific Islands. No immigration. Two key health issues include health care allocation and the question of reimbursement for medical care. - 20% of Native Hawaiians live in Hawaii. Health care resources in Honolulu and thus an inadequate number of health care professionals on other islands. Health belief suggests that a healer cannot be reimbursed directly because it is a question of righteousness.

American Indians and Alaska Natives Overview and Leading Causes of Death

- 2% of the population in 2014. Comprise of different American Indian tribal groups and Alaskan villages. 566 federally recognized Indian tribes in the US. Cultural values include the emphasis on freedom, autonomy, and respect for living things, an expectation that tribal or village members will bring honor and respect to their families, clans, and tribes. - Prior to the arrival of European explorers 12 million AI/ANs lived. Exposure of diseases and ecological changes decimated the population. Some assimilated. - Income in 2013 was 36,252. Poverty rate was 29.2% which is the highest among all racial and ethnic groups. HS completion rates were the lowest of any. - NA culture is that people strive for a close integration within the family, clan, and tribe and live in harmony with their environment (occurs with physical mental and spiritual levels). Individual wellness is considered the harmony and balance among mind, body, spirit, and environment. - Conflicts between the medical/public health approach and the approaches used by NA healers.

Diabetes

- 24 million people in the US have diabetes mellitus with increasing morbidity and mortality rates for all groups - Native Americans aged 15-19 have the highest rates of diabetes type 2. Lowest rates found in Alaska Natives and highest rates found in Pima Indians in Arizona. - Death rates: White non-Hispanics diabetes are two and half times higher among AA and AI. Lower rates in Asians. - Other complications from diabetes > heart disease, stroke, blindness, and kidney disease - Diabetes is the leading causes of cases in blindness aged 20 to 74 and leading cause of end stage renal disease (ESRD) accounting for half the new cases. - Inpatient hospitalization most expensive venue for diarist care. AA and Hispanics are the highest to use hosiptal admission for long term care of diabetes.

Governmental efforts

- CDC Racial and Ethnic Approaches to Community Health (REACH): educate and import people to seek and obtain needed health services - Communities Putting Prevention to Work (CPPW) - HHS Strategic Action Plan to End the Tobacco Epidemic, and the Efforts to Reduce Disparities in Influenza Vaccination - HHS Action lan to Reduce Racial and Ethnic Health Disparities and in 2013 released the second Health Disparities and Inequalities Report.

Cardiovascular Diseases

- Coronary heart disease and stroke kills more Americans annually than any other disease. Claims mover lives than the next five leading causes of death combined. - Death rates from coronary HD and stroke vary between ethnic and racial groups. - Modifiable risk factors for coronary HD and stroke is hypertension. One in three American adults suffer from hypertension. Highest prevalence in AA and they ten to develop earlier than whites. 90-95% of the causes hypertensions in all races and ethnic groups are unknown. - Secondary prevention or screenings are essential for hypertension.

Infant Mortality

- Death of an infant before his or her first birthday - correlated to general health and well-being of the nation - US made significant improvement in the 20th century regarding infant health - AA infant death rate are more than two times the infant deaths of American infants. - Two of the reasons that explain AA infant death (1) lack of prenatal care (2) low weight babies - Women who receive early and continuous prenatal health care have better outcomes. AA, NA, and Hispanic women are less likely to receive this care. AA and NA are more likely to give birth to low weight babies.

HIV Infection/AIDS

- HIV is a chronic condition that damages the body's immune system and makes a healthy person resist a variety of infections and disorders resulting to the condition of AIDS. - No cure or vaccine. CDC estimates that 1.2 million people in the US were living with diagnosed or undiagnosed HIV by the end of 2012. Higher rates in AA. - Proportion of cases has increased among AA and Hispanics and decreasing among whites. In 2012, AA and Hispanics (represented less than the population) accounted for more than half of the number of HIV/AIDS cases. Higher AIDS death rates for AA and Hispanics - AA and Hispanics have a higher prevalence of unsafe or risky health behaviors (unprotected sex and intravenous drug use), existing co-conditions (genital ulcer disease), and the lack of access to health care for early diagnosis and treatment. - Barrier is that HIV/AIDS are not viewed as the highest priorities in some minority communities. - Prevention: better health education to reduce or eliminate unsafe behaviors and increase access t medical resources for existing cases.

public health research

- Health is associated with the more years of education, having more income, prestigious job, and living in superior neighborhoods. - Elevated levels of morbidity, disability, and mortality are associated with less education, lower income, poverty, unemployment, and poor housing. - social determinants of health play a role in the association of race and ethnicity with health and life expectancy. - Relationship of SES and health occurs at every socioeconomic level and for a broad range of SES indicators including life expectancy.

growing ethnic groups

- Hispanics were the fastest growing group in the last two decades. Asians were the fastest in between 2010 - 2014 (due to International migration)

psychological power

- Individual sense of potency demonstrated in self confident behavior - Results of successful action in social and political domains.

biological genetic makeup

- More than 90% of the differences in genetic makeup occur within racial and ethnic groups rather than between the groups. - Health status among minority groups are better understood in terms of groups living circumstances.

New standards of Directive 15 in 1997

- New classification standards expanded to 5 races: separating Asian and Native Hawaiian or Other Pacific Islander into two categories. Hispanic was changed to Hispanic or Latino and Negro was changed to black or AA. - Reporting of more than one race was encouraged and that the Hispanic origin question should precede the race question - 1997 HHS adopted policy supporting the inclusion of new revised federal standards for racial and ethnic data for employment in the HHS data systems and thus developing and measuring Healthy People 2020 objectives - Updated by the Office of Management and Budget Statistical Policy > data should be collected both on race and ethnicity.

African Americans Overview and Leading Causes of Death

- People having origins in any of black racial groups from Africa. - 2014 AA made 14.3% of the population. - The second largest minority group. More than one half live in southern states. All states have seen changes in AA population in the last decade. - From the 2014 American Community Survey: 84.4 of blacks age 25 and older obtained a HS diploma and 19.7% had a bachelor degree of higher. AA also contributed to lower HS graduation rates 67% compared to the national average of 79% during 2010-11. HS graduation rates increased 3.7% compared to 2.6% of whites - Median income for AA have rank below racial and ethnic groups. In 2013 about one in four 27.2% live in poverty (three times the rate to non Hispanics white) 40% of blacks in Minnesota, Miss, and Tenn are classified as poor. - Views physical health may be perceive illness as being the result of conflicts in life, lack of harmony with nature, and or punishment from God. - Effect of slavery on health. At the end of the civil war > poverty, discrimination, and poor living conditions led to high diseases disability, and death among the black Americans. Lack of access to formal health care lead to depending on traditional health methods (roots herbs barks teas) - Effects of social factors related to racism discrimination and the Tuskegee syphillis impacts the health of the AA

strategy to achieve the goal

- Promote empowerment of marginalized people. - expand clinics, education, health services, and partners - health literacy

Indian Health Service

- Provides health services to the 566 federally recognized Native Americans and Alaska Natives tribes. Operated hospitals, clinics, and health stations, and a variety of other programs. - Goal is to impose the health status of bth urban and reservation AI and Alaska Natives.

diversity

- Refers to the differences in gender, age groups, sexual orientation, SES status, language preferences, religion, political views, and special needs as well as race and ethnicity - Multifaceted and dynamic

SES and health

- Relationship is a gradient - More family income increases above poverty, the more health improves; however, the greater the gap in income and health. - Gradient effect are related to the gap between the privelaged and the non privileged. Minority groups occupy the lowest SES ranking in the US and it is concerning because the Health People 2020 objectives found that greatest progress was among high SES groups.

Cancer Screening and Management

- Second leading cause of death in the US. 550,000 deaths and more than 1.6 million new cases of invasive cancer. Cancer mortality higher for AA (261.5 per 100,000) and Lowe in Asian/Pacific Islander women (91.2 per 100,000) - More than half the cases are cancers of the lung, colon and rectum, breast, and prostate. - Cancer incidence and cancer death rates per 100,000 population were highest among AA for lung, colon and rectum, breast, and prostate cancer compared to white Americans, Asian/Pacific Islanders, AI/ANs, and Hispanics - Higher mortally rates are observed from lung cancer among Hispanics. - Disparities in cancer incidence and death rates in minorities > lifestyle factors, late diagnosis, and access to health care. - Primary cancer prevention: Smoking is the most preventable cause of lung cancer deaths. Death rate of lung caner is 20% higher for AA compared to whites. AA have a higher incidence of smoking than whites. - Secondary cancer prevention: Racial/ethnic disparities in lower survival rates can be attributed to lower cancer screening rates. Two cancers of interest: breast and colorectal. Colorectal cancer is the second leading cause of cancer deaths in the US and leading cause of death among nonsmokers. CDC states 1,900 deaths could be prevented for every 10% increase in colonoscopy screening. - Breast cancer second leading cause of cancer death among women. Survival rates can increase if cancer is detected early through monthly self-examination and or periodic breast X-rays. Mammography not a early section procedure that minority women use. - Healthy People 2020 goal: t least 81% of women from all racial and ethnic groups age 50 or older receive mammogram within the preceding 2 years.

U.S. Government, Native Americans and Provision of Health Care

- Some tribes are sovereign nations because of the treaties they have with the US. Tribal sovereignty is when tribes transferred all land in the US to the federal government in return for certain services. - Health services began in 1832. First medical efforts were by the Army who vaccinated NA against small pox and applied sanitary procedures to curb other communicable disease.

Americans of Hispanic Origin and Leading Causes of Death

- Term Hispanic introduced by OMB in 1977 which created the ethnic category of persons of Mexican, Puerto Rican, Cuban, Central American, South American, or some other Spanish origin regardless of race. - 1997 term was changed to Hispanic or Latino. For the purposed of data collection, ethnic distinctions was Hispanic or non Hispanic - Hispanic population is the most rapidly growing ethnic groups. In 2014, Americans of Hispanic origins made up 17.4% of the population. Largest minority group in the US. Decreasing number if immigrants from this population. - Census Bureau over 1 million Hispanics reside in Arizona, California, Colorado, Florida, Illinois, NY, and Texas - Heterogeneous group representing people living in vast geographic regions from Mexico to Tierra del Fuego in South America. - People of Mexican origins are the largest of the Hispanic group. Then Puerto and Cubans - 20% of youth between ages 10 to 19 was from Hispanic origin in 2012. Educational attainment lower compared to whites. - Median income was lower in 2013 (40,963)than Asians (67,065) and whites (58,270). Poverty rates of foreign born Hispanics higher than those born in the US. Poverty Rates of person of Hispanic origin was 23.5% in 2013 (three times the rate for whites)

empowerment

- Three types of power: social political and psychological - Need three powers to take place. - Once people are empowered they need to transfer to the communities. When communities are empowered they can make changes and solve problems. Once united, they are in the position to influence decision makers at governmental levels.

Immigrant and Refugee Health

- UN High Commissioners for Refugees there were some 19.5 million refugee around the world in 2014. - Fear of persecution for reasons of race, religion, nationality, political opinion, or membership in a social group. - War and ethnic, tribal, and religious violence are the leading causes of refugees fleeing from their countries. Those arriving the US may be seeking political asylum, refuge from war, or escape famine or other environmental disasters. - From developing countries or with unstable governments or affected by the civil war.

Child and Adult Immunization Rate

- With immunization practices, many infectious diseases have been reduced - Childhood immunization (protected from vaccine-preventable illnesses). For children aged 19 months to 35 months is the 4:3::3:3:3:1 vaccine series. - Healthy People 2020 target coverage for recommended childhood immunizations - Important for those 65 and older to get vaccines to prevent infectious diseases that can cause illness, disability, or death. Two important adult immunizations.

health literacy

- a way to improve health status of diverse populations - the degree to which people have the capacity to obtain process and understand basic health information and services needed to make health decisions - focus on the primary language spoken and in doing so they neglect to ascertain their ability to understand retain and apply health information they receive

Curanderismo

- common form of Hispanic folk medicine - healers ability includes varied repertoire of religious belief systems, herbal knowledge, witchcraft, and scientific medicine - Includes Herbert, sobador, espiritista - though physical health was the matter of fortune, balance between hot and cold, reward from God for good behavior

Cultural Competence

- cultural differences present obstacles in implementing effective community health programs and services - Culturally appropriate services lead to improved outcomes, efficiency, and satisfaction for clients.

health disaparities

- differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups - related to inequality in education, income, SES status, environmental disadvantages, and limited access to health care services ex. life expectancy for non Hispanic whites (79.1 years) and AA (75.5) despite the decreases in the leading causes of death

Affordable Care Act

- enacted in 2010 - Address the race/ethnic racial data and the need to develop culturally appropriate efforts to reach diverse populations to improve the health status of all populations and decrease health disparities -

1985 Secretary's Task Force Report on Black and Minority Health

- first documented the health status disparities of minority groups in the US - Identified the 6 causes of death that accounted for more than 80% of the excess mortality observed among AA and others. - Contributed to the development of Healthy People Initiative objectives that resulted in some measurable decreases in age adjusted death rates for seven specific causes of death by the year 2020

Race and Health Initiative

- key component of Healthy People 2020 goal to achieve health equity, eliminate disparities, and improve the health of all groups - committed the nation to the goal of eliminating health disparities in 6 areas (1) infant mortality (2) cancer screening and management (3) cardiovascular disease (4) diabetes (5) HIV/AIDS (6) adult and child immunization - reaffirms the government's focus on minority health issues by emphasizing the six health issues that account for a burden of disease that is highly modifiable if interventions were applied - These initiatives are intertwined with Healthy People 2020 and the goals of the nations for the next decade

1985 Secretary's Task Report on Black and Minority Health

- laid foundation for next three decades of Healthy People Initiatives designed to decrease health disparities and to provide culturally competent health care services and health promotion and disease prevention programs - much to be done in achieving the goals of Healthy People 2020 and UN Millennium Development Goals

Empowering the Self and the Community Healthy People 2020

- principle: greatest opportunities for reducing health disparities are in empowering people to make informed health care decisions and in promoting community wide safety, education and access to health care (found in the Sustainable Development Goals in 2015).

demographic changes of race and ethnicity

- started in 1970 - By 2060, over 1/2 of the population will be racial minorities. White population expected to decrease to 43.6%.

6 main features of ethnicity

1. Common proper name, to identify and express the essence of the community 2. Myth of common ancestry that includes the idea of common origin in time and place and that gives an ethnie a sense of fictive kinship 3. Shared historical memories, or better, shared memories of a common past or pasts, (heroes events commemoration) 4. One or more elements of common culture, which need not to be specified but normally include religion, customs, and language 5. A link with a homeland, not necessarily its physical occupation by the ethnie, only its symbolic attachments to the ancestral land, as with diaspora peoples 6. Sense of solidarity on the part of at least some sections of the ethane's population

Snyder Act

1921. Created the Bureau of Indian Affairs Health Divisions that gave more emphasis in providing heath services to Native Americans.

Healthy People 2020 and social determinants of health

Addresses through its goal of creating social and physical environment that promote good health.

Equity in Minority Health "Race and Health Initiative"

Aims consists of consultation and collaboration among federal agencies (state, local, and tribal government) and community professionals to research and address issues of education, income, environment, and other socioeconomic factors that affect health. - These are inseparable from other social problems, multiple resources are required, solutions may work for one and not the other.

caucasians

Americans of Hispanic origins

refugees and immigrants

As a single group they present many special concerns not seen in minority who are born and raised here. Most refugees arrive from developing countries, poor, little formal education, and little work skills. Can come with serious health problems. Majority are young women of childbearing age. Most come from Latin American and Southeast Asian countries. They could bring diseases. Barriers to social integration but contribute to US culture.

racial/ethnic distribution of the US population, 2014

Black 13.2 American Indian 1.2 Asian 5.4 Native Hawaiian 0.2 Hispanic/Latino 17.4 Two or more 2.5 White 77.5

ACA and data collection

Continues to update data collection on race and ethnicity in surveys. HHS works with health data systems that do not collect self-reported race or ethnicity. Increases reliability and amount of data means that we can assess the outcomes related to meeting the goal fo Healthy People 2020 "achieve health equity, eliminate disparities, and improve the health of all groups"

4:3:3:3:3:1 vaccine series

DTP/DT/DTaP, poliovirus vaccine, measures, mumps, and rubella vaccine (MMR), haemophilus influenzae type b vaccine, Hep B vaccine, and varicella vaccine

cultural and linguistic competence

Defined by the CLAS set of congruent behaviors, attitudes, and polices that come together in a system, agency, or among professionals that enables effective work in cross cultural situations Culture: integrated patterns of human behavior (language, thoughts, communication, actions, customs, beliefs, values, and institutions of racial ethnic, religious or social groups Competence: to function effectively as an individual or organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities

Secondary cancer prevention

Early detection of cancer through screening tests. The earlier a cancer is detected the greater chance of survival.

Key social determinants of health among racial and ethnic groups in the US

Education and income because the predict the greatest proportion of heath status variance among individuals. These factors can be indirect causal associations or intermediary factors.

Unequal Treatment: Confronting Racial and Disparities in Health Care

From the report of the Institute of Medicine. Identify health disparities and provides a blueprint for addressing them as a nation.

2013 adult immunization schedule and the infectious disease objectives in Healthy People 2020

Influenza and pneumococcal diseases. - Goal is to increase the number of non institutionalized adult 65 and older who are immunized annually against influenza and who have ever received an immunization against pneumococcal disease to 90% - Immunization rates among non-minorities for influenza and pneumococcal infections are lower than for white Americans. Need to have increased efforts in the minority population.

greater access to health care

Local health departments need to expand the available clinics, increase education opportunities, request culturally competent health services, and to be equal partner in addressing environmental issues.

Leading Causes of Deaths for Hispanics 2010

Malignant neoplasms Heart disease Accidents cerebrovascular diseases (strokes) Diabetes Chronic liver disease and cirrhosis Chronic lower rep disease Alzheimer Influenca and pneumonia Nephritis, nephrotic syndrome, and nephrosis

community health educators

Need to educate groups and communities of diverse cultural background (cultural competence). And health interventions and activities should be understanding and appreciation of the cultural characteristics of the target group. Take in consideration communication differences. Take in account distance zone, nonverbal cues, gender roles, and dress code.

National Health Care Quality and Disparities Reports

Produced by the Agency for Health Care Research and Quality. Seeks to quantify disparities and propose strategies to eliminate them.

HHS and Office of Minority Health and Health Disparities

Published standards for culturally and linguistically appropriate services (CLAS) in health care 2013. First recognized standards of cultural and linguistic competence in health care service delivery

A framework for understanding the relationship between race and health

Race (effects vary by gender and age) - Biological, cultural, socioeconomic, racism, political, historical, and legal - Health practices > smoking, alcohol, nutrition, other - Psychosocial stress > smoking, alcohol, nutrition, other - Environmental stress > residential, occupational, other - Psychosocial resources > social ties, perceptions of control, coping patterns - Medical Care > need, access, quality

Problems with race and ethnicity

Race is a social category that has changed over time and varies across societies and cultures. Self-reported data can be unreliable because people can have a hard time classifying their racial or ethnic identity on standardized forms. Nonfederal health data systems do not collect self-reported race or ethnicity data or may be uncertain of who recorded it.

Educational Attainment of Population aged 25 and older and real household median incomes by race and Hispanic origin

Rank high to low - High School Degree: Asians, Whites, AI/AN, AA, Hispanics - Bachelor's: Asians, Whites, Black, AI/AN, Hispanics - Income: Asians, Whites, Hispanic, AI/AN, AA

Health Data Sources and Their Limitations

Reporting race and ethnicity data is needed because it provides essential information to target and evaluate public health inventions aimed at under represented populations. But with the diversity in race and ethnicity, there are many problems in the way the variables are assessed on collection, analysis,, and dissemination of health information.

Health People Initiative and ACA of 2010

Resources in elimination of health disparities. Any report can teach changes over period of time.

ethnicity

Subcultural group within a multicultural society. Membership of ethnic group is based on a common national or tribal heritage.

I. Racial and Ethnic Classification race

The categorization of parts of the population based on physical appearance due to particular historical social and political forces. This is a subjective categorization into racial categories.

US Census Bureau

US population reached 318 million in 2014. 62.2% of Americans identified as white non hispanics and 37.8% are members of racial and ethnic minority groups.

aliens

a person born in owing allegiance to a country other than the one in which he/she lives they are not citizens, they are only allowed to start in the foreign country for a specified period of time defined by law or policy

refugee

a person who flees one area or country to seek shelter or protection from danger in another

social power

access to bases of production like information, knowledge of skills, participation in social organizations, and financial resources (increase productivity = influence change)

unauthorized immigrant

an individual who entered this country without permission

Social Determinants of Health and Racial and Ethnic Disparities in Health social determinants of health (WHO)

circumstances in which people are born, grow up, live, work, and age, and the systems put in place to deal with illness as well as life-enhancing resources (food supply, housing, economic and social relationships, transportation, education, and health care)

acculturated

cultural modification of an individual or group by adapting to or borrowing traits from another culture

Leading Causes of Death for American Indians/Alaska Natives 2013

disease of heart neoplasms accidents diabetes chronic liver disease and cirrhosis cerebrovascular disease (stroke) intentional self harm influenze and pneumonia nephritis

healthy people 2020 cultural competence principle

every person deserves equal access to comprehensive, culturally competent, community based health care systems that serve the needs of people and promote community health

Leading Causes of Death for AA 2013

heart disease cancer stroke unintentional injuries diabetes chronic lower respiratory disease nephritis homicide sepsis Alzheimer disease

Second Health Disparities and Inequalities Report

identify and address the factors that lead to heath disparities among racial, ethnic, geographic, socioeconomic, and other groups so that barriers to health equity can be removed - general tool to achieve these goals are Health People 2020

immigrants

individuals who migrate from one country to another for the purpose of seeking permanent residence immigration policies provide the distinct waves of legal immigrations to the US from different countries 13% of the US population in 2013 and they contribute to the expansion of US population and have increased steadily since 1970s

Leading Causes of Death of Asian Americans or Pacific Islanders 2013

neoplasms disease of heart cerebrovascular disease (stroke) accidents diabetes influenza and pneumonia chronic lower respiratory diseases Alzheimer Nephritis Intentional self-harm

Table 10.2 Selected Culture-Related Components in the ACA

page 258

racial and ethnic minorities

poorer health status, lower levels of insurance coverage, inadequate access to health care services

Primary cancer prevention

preventing the occurrence of cancer

Minority Health and Health Disparities minority health

refers to the morbidity and mortality of American Indians/Alaska Natives, Americans of Hispanic origin; Asians and Pacific Islanders, and black Americans in the US

rich cultural tapestry

result of much debate that divides the nation

minority group

subgroup of the population that consists of fewer than 50% of the population

Definition shows

that culture is a factor in both how community health professionals deliver services and how community members respond to community health programs and interventions

majority

those with characteristics that are found in more than 50% of a population

biased analysis

two separate data reporting systems are used to obtain rates by race ad Hispanic origins