Gloria A' Sanchez, Miriam Ibrahim and Sharon E' Barrett

1
Creating Health Care Equity forWomen of Color
The First National Conference of the Academy for
Health Equity
US Department of Health and Human
Services Minority Womens Health Panel of Experts

• Gloria A. Sanchez, Miriam Ibrahim and Sharon E.
  Barrett

Session V Denver, Colorado June 26-27, 2008
2
Our Country Overview of Demographics
MWHPE
Source Women of Color Health Data Book
Adolescents to Seniors, 2006, ORWH, NIH
Publication 06-2427
3
Our Country Overview of Demographics
Women of Color Encompass 5 major groups
Source Women of Color Health Data Book
Adolescents to Seniors, 2006, ORWH, NIH
Publication 06-2427
4
Our Country Overview of Demographics
MWHPE
Source U.S. Census Bureau, Population Division,
2008 http//www.census.gov/population/www/pop-prof
ile/natproj.html
5
Our Country Projected Demographics
MWHPE
Source Women of Color Health Data Book
Adolescents to Seniors, 2006, ORWH, NIH
Publication 06-2427
6
Uninsured Women

• 47.8 million in the US are uninsured
• Women of color are disproportionately represented
  among women who are uninsured
• 32 of the female population represent women of
  color (2003)
• 51 of uninsured women are women of color (2003)

Source Women of Color Health Data Book
Adolescents to Seniors, 2006, ORWH, NIH
Publication 06-2427
7
The Health Care Dilemma

• Eliminating Health Care Disparities
• Creating Health Care Equity

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Institute of Medicine Unequal Treatment
SUMMARY OF FINDINGS

• Finding 1 1
• Racial and ethnic disparities in health care
  exist and, because they are associated with worse
  outcomes in many cases, are unacceptable.

Source Unequal Treatment Confronting Racial and
Ethnic Disparities in Health Care, Editors B. D.
Smedley, et al., 2002, The National Academies
Press, Washington, D. C., www.nap.edu
www.iom.edu
9
Institute of Medicine Unequal Treatment
SUMMARY OF FINDINGS

• Finding 2 1
• Racial and ethnic disparities in health care
  occur in the context of broader historic and
  contemporary social and economic inequality, and
  evidence of persistent racial and ethnic
  discrimination in many sectors of American life.

Source Unequal Treatment Confronting Racial and
Ethnic Disparities in Health Care, Editors B. D.
Smedley, et al., 2002, The National Academies
Press, Washington, D. C., www.nap.edu
www.iom.edu
10
Institute of Medicine Unequal Treatment
SUMMARY OF FINDINGS

• Finding 3 -1
• Many sources including health systems,
  healthcare providers, patients, and utilization
  managers may contribute to racial and ethnic
  disparities in healthcare.

Source Unequal Treatment Confronting Racial and
Ethnic Disparities in Health Care, Editors B. D.
Smedley, et al., 2002, The National Academies
Press, Washington, D. C., www.nap.edu www.iom.edu
11
Institute of Medicine Unequal Treatment
SUMMARY OF FINDINGS

• Finding 4 1
• Bias, stereotyping, prejudice, and clinical
  uncertainty on the part of healthcare providers
  may contribute to racial and ethnic disparities
  in healthcare. While indirect evidence from
  several lines of research support this statement,
  a greater understanding of the prevalence and
  influence of these processes is needed and should
  be sought through research.

Source Unequal Treatment Confronting Racial and
Ethnic Disparities in Health Care, Editors B. D.
Smedley, et al., 2002, The National Academies
Press, Washington, D. C., www.nap.edu
www.iom.edu
12
Institute of Medicine Unequal Treatment
SUMMARY OF FINDINGS

• Finding 4 2
• A small number of studies suggest that racial
  and ethnic minority patients are more likely than
  white patients to refuse treatment. These
  studies find that differences in refusal rates
  are generally small and that minority patient
  refusal does not fully explain health care
  disparities.

Source Unequal Treatment Confronting Racial and
Ethnic Disparities in Health Care, Editors B. D.
Smedley, et al., 2002, The National Academies
Press, Washington, D. C., www.nap.edu
www.iom.edu
13
Missing Persons Minorities in Health
Professions

• There is an imbalance in the makeup of the
  nations physicians, dentists, and nurses. This
  imbalance contributes to the gap in health status
  and the impaired access to health care
  experienced by a significant portion of our
  populationAfrican Americans, Hispanics, American
  Indian, and certain segments of the nations
  Asian/Pacific Islander population are not present
  in significant numbers. Rather, they are
  missing.
• We understand the dimensions of the problem.

Source A Report of the Sullivan Commission on
Diversity in the Healthcare Workforce, 2004,
http//www.aacn.nche.edu/Media/pdf/SullivanReport.
pdf
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Sullivan Commission Recommendations
37 recommendations are based on 3 principles

• To increase diversity in the health professions,
  the culture of health professions schools must
  change
• New and nontraditional paths to the health
  professions should be explored and
• Commitments must be at the highest levels of our
  government and in the private sector

Source A Report of the Sullivan Commission on
Diversity in the Healthcare Workforce, 2004,
http//www.aacn.nche.edu/Media/pdf/SullivanReport.
pdf
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Factors Which Contribute to Health Disparities

• Lack of Access
• Financial barriers
• Socioeconomic barriers
• Psychological barriers
• Racial/ethnic barriers
• Communication barriers
• Language
• Cultural
• Low health literacy

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Creating Health Care Equity
Multi-pronged Approach

• Systems of care
• Clinical practices
• Consumer/patient engagement
• Networking

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Creating Health Care Equity

• Systems of Care
• Recruitment and retention of a racially and
  ethnically diverse health care workforce
• Development of cultural and linguistic
  organizational philosophy, policies and practices
  
• Creation of a culturally and linguistically safe
  environment for engaging patient - clinician
  relationships and information exchange

18

Creating Health Care Equity

• Clinical Practices
• Integration of patient-centered communication and
  care
• Ongoing professional training to enhance
  cultural, linguistic and health literacy
  competences
• Provision of language services and interpreters

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Creating Health Care Equity

• Consumer/Patient Engagement
• Developing a medical home
• Taking Ownership of Health Condition
• Dialogue with Care Team
• Joint decision making and goal setting with
  treatment team
• Being health literate
• Being computer savvy
• Using culturally and linguistically appropriate
  patient educational materials and Internet sites

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Creating Health Care Equity

• Networking
• Sharing information resources
• Developing partnerships for
• research
• data collection and analysis
• advocacy
• service delivery

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Office on Womens HealthDepartment of Health
andHuman Services

• Established in 1991
• Vision
• All Women and Girls are Healthier and Have a
  Better Sense of Well Being.
• Mission
• Provide leadership to promote health equity for
  women and girls through sex/gender-specific
  approaches.

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The Minority Womens Health Panel of Experts

• Established by the OWH in 1997
• Mission
• To ensure that racial/ethnic minority focus is
  incorporated in all OWH programs, policies and
  initiatives.
• Purpose
• Provides input to/serves as a resource for the
  U.S. DHHS OWH to improve the health of women and
  in the development of minority womens health
  initiatives and
• Provides input to Department/Secretarial
  initiatives to enhance the health of minority
  women in the U.S.

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OWH Minority WomensHealth Panel OWH/MWHPE

• Panel Composition
• Health care clinicians/professionals
• Community advocates
• Academicians
• Racial and Ethnic Representation
• African American
• Alaskan Native/Native American
• Asian American
• Hispanic
• Native Hawaiian
• Pacific Islander

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OWH/MWHPE Contact Information

• OWH
• Wanda K. Jones, DrPH
• Deputy Assistant Secretary for Health (Womens
  Health), US Department of Health and Human
  Services
• Frances E. Ashe-Goins, RN, MPH
• Deputy Director, Office of Womens Health
• E-mail Frances.ashegoines_at_hhs.gov
• MWHPE
• Adrienne Smith, PhD, MS, CHES
• Public Health Advisor, Division of Program
  Coordination
• Email Adrienne.smith_at_hhs.gov

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Acknowledgements

• Planning Group
• Gloria Sanchez Gloria.A.Sanchez_at_kp.org
• Sharon Barrett semily1_at_msn.com
• Miriam Ibrahim miriam.ibrahim_at_renogov.org
• Suganya Sockalingam - suganya_at_mindspring.com
• Vickie Mays -  maysv_at_nicco.sscnet.ucla.edu
• Nancy Walch - walchnancy_at_yahoo.com
• Darlene Yee-Melichar dyee_at_sfsu.edu
• Nereida Correa correanereida_at_aol.com
• Dee Baldwin dbaldwin_at_gsu.edu
• Oneila Lage - OLage_at_med.miami.edu