Health Disparities

Health Equity

"Health equity implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential" (Braveman, 2006, p. 168) *Health equity = absence of systematic disparities in health between groups with different social advantage/disadvantage (e.g. wealth, power, prestige).

Morbidity

Disease

Prevalence

the number of new and old cases of a disease/injury in a given year

Incidence

the number of new cases of a disease/injury in a given year

Race

A family, tribe, people, or nation belonging to the same stock a class or kind of people unified by shared interests, habits, or characteristics

Inequity

A instance of unjustness or unfairness. *More subjective/ethical than inequality. *Inequity often the result of an equality *These inequitable differences in health are the concern for our field because they ARE PREVENABLE

Health

A state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity

Ethnicity

According to Merriam-Webster Dictionary, ethnicity means have affiliation with an ethnic group. *Ethnic means a : of or relating to large groups of people classed according to common racial, national, tribal, religious, linguistic, or cultural origin or background b: being a member of a specified ethnic group c: of, relating to, or characteristic of ethnics

Physical activity

Adults whose family income is above the poverty level are more likely to meet the 2008 Physical Activity Guideline for aerobic activity than adults whose family income is at or near the poverty level. * More non-Hispanic white adults (22.8%) meet the 2008 Physical Activity Guidelines for aerobic and muscle-strengthening activity than non-Hispanic black adults (17.3%) and Hispanic adults (14.4%). * Men (52.1%) are more likely than women (42.6%) to meet the 2008 Physical Activity Guideline for aerobic activity. * Younger adults are more likely to meet the 2008 Physical Activity Guideline for aerobic activity than older adults.

Tobacco Use?

American Indians report the most tobacco use, 21.6% of males, 16.5% of females

Discuss the health disparities related to Stoke

Black men and women are most likely to have heart failure, high blood pressure, and stroke; black women are also more likely than other women to have coronary heart disease

Discuss the health disparities related to Heart Disease.

Black men and women are most likely to have heart failure, high blood pressure, and stroke; black women are also more likely than other women to have coronary heart disease.

Discuss the health disparities related to Prostate Cancer.

Black men are 50 percent more likely to have prostate cancer than whites but are more than twice as likely to die from it.

Discuss the health disparities related to CRC

Blacks have higher incidence of and mortality from colorectal cancer than all other racial/ethnic groups. Hispanics are less likely to receive colorectal and cervical cancer screenings than non-Hispanics

Mortality

Death

Health Disparity

Differences in health status, we assesse these differences by examining differences in health status by population group .* Example: the disproportionate numbers racial/ethnic minority citizens in the U.S. that have inadequate access to health care. *Is it a health inequality? -Yes, since there is a difference in rates of access to health care amongst segments of the population. Is it a health inequity? *Is it unjust/unfair that certain populations lack health care? If yes, then it is an inequity In Public Health, we are working to achieve health equity = equal opportunity to achieve good health or quality healthcare/treatment

Social Determinants: Education

Education is an important social determinant of health. People with higher education tend to be healthier then those with lower educational attainment. There are various pathways by which education leads to better health. First, level of education is highly correlated with other social determinants of health such as the level of income, employment security, and working conditions. Viewed in this light, education helps people to move up the socioeconomic ladder and provides better access to other societal and economic resources.

Social Determinants: Employment

Employment provides income, a sense of identity and helps to structure day-to-day life. Unemployment frequently leads to material and social deprivation, psychological stress, and the adoption of health-threatening coping behaviors. Lack of employment is associated with physical an mental health problems that include depression, anxiety and increased suicide rates.

Inequality

Examples of health inequalities *People who are older die more often than people who are young. IS IT PREVENTABLE? NO-so the difference here, or the health disparity between young and old, in heart disease, for example is not inequitable.

Top 5 leading causes of death in the U.S.

Heart Disease, Cancer, Chronic lower respiratory disease, stroke, & accidents.

Discuss the health disparities related to Cervical Cancer.

Hispanic women are twice as likely to have cervical cancer than whites; black women are twice as likely to die from the disease

Social Determinants: Housing

Housing influences health in many ways. People experience qualitatively different material environments depending on their housing quality. Overcrowding allows for transmission of respiratory and other illnesses. Some Canadian homes, especially on Aboriginal reserves, lack even clean water and basic sanitation- a fundamental public health risk. Housing provides a platform for self-expression and identity. High housing cost reduce the resources available to support other social determinants of health. Living in poor housing creates stress and unhealthy means of coping such as substance abuse.

Social Determinants: Income

Low income predisposes people to material and social deprivation. The greater the deprivation, the less likely individuals and families are able to afford the basic prerequisites of health such as food, clothing, and housing. Deprivation also contributes to social exclusion by making it harder to participate in cultural, educational, and recreational activities. In the long run, social exclusion affects one's health and lessens the abilities to live a fulfilling day-to-day life.

Violence

Non-hispanic black males between the ages 15-24

Discuss the health disparities related to Breast Cancer.

Notably, non-Hispanic white women have the highest incidence of breast cancer. Black women, however, still have the highest mortality rate from this disease among all races and ethnicities Black breast cancer patients are also less likely to receive a complete diagnostic evaluation within 30 days of a patient-noted abnormality or abnormal mammogram.

1. How does childhood SES impact adult health

Socioeconomic status (SES) exposures during childhood are powerful predictors of adult cardiovascular morbidity, cardiovascular mortality, all-cause mortality, and mortality due to a range of specific causes. Adult and childhood SES are correlated. For example, those with a college education and relatively wealthy parents are more likely to have access to educational opportunities and higher status, well-paying careers. Consequently, it is possible that childhood SES does nto play a role in adult health, but merely represents a marker of future adult SES, which in turn influences adult health.

Epidemiology

Study of trends in a disease

Discuss the health disparities related to HIV/AIDS

The case rate for black adults and adolescents is 10 times greater than for white adults and adolescents (Chart 3-17). Yet black HIV patients are less likely to receive antiretroviral therapy, even after controlling for access to care.9 AIDS cases are also substantially more common in the Hispanic population than the white population; Hispanics are 3.5 times more likely to have AIDS than whites.

Community Health

The health status of a defined group of people and the government/public efforts to promote, protect, and preserve their health.

3. What does the concept "income gradient in health" mean?

a. At each level of income, health status varies - this is called "income gradient in health status"; poor are less health than the middle-income who are less healthy than the wealthy

3. Discuss how race is a social construct.

a. Race is a social construct because there aren't any scientific/genetic/biological differences between people of different races i. Genetically, humans are humans ii. Genetically, there is more intra-race variation than inter-race variation iii. Genetic variations tend to be the result of geographical location more than skin color iv. Goodman says that race is a social concept with biological consequences

2. Compare/contrast these definitions with how the Office of Management and Budget conceptualizes race/ethnicity.

a. Race is social/cultural, not biological or skin color b. Ethnicity is cultural

2. How have income disparities influenced life expectancy in the United States?

a. The growth in life expectancy parallels the growth of income inequality b. Affluent people have experienced greater gains - shifting the trends upwards

4. In the United States, why is having categories of "race/ethnicity" beneficial?

a. We now rely on and use the data to improve the social, cultural, and health conditions of those suffering the most; helps us identify inequities b. Its become cultural - an important means for self-identification

5. Discuss how the income gradient in health varies by race/ethnicity, focusing on findings from Braveman, et al. (2010).

a.Looking at health status variations by SES within each racial/ethnic group we find the gradient still exists within each racial/ethnic group b.Poor Hispanics are less healthy than wealthy Hispanics, for example c. However, when you compare health status by income between racial/ethnic groups, differences still exist, but they aren't consistent in this study

Disparity

ii. Gender, Race or ethnicity, Education, Income, Disability, Geographic location, Sexual orientation