Socioeconomic Status and Health Disparities Among Older Adults

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Socioeconomic Status and Health Disparities Among
Older Adults

• Lovell A. Jones, PhD
• Director, Center for Research on Minority Health
• Director, Reproductive Biology Program
• University of Texas M.D. Anderson Cancer Center
• Houston, Texas

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What do we know and not know about environmental
health disparities among older adults?
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We dont know much!

• Insufficient research on geriatric environmental
  health issues in the US
• No known studies on environmental health
  disparities for the elderly of minority or
  medically underserved populations
• 2005 American Lung Associations publication on
  air pollution did not include this population

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Whats the problem?

• Younger people are often easier to study than
  older people
• Aggregated data
• Everyone over age 65 is often put in the same
  category regardless of health status
• Seniors are often grouped in the susceptible
  population category
• Minority seniors are often ignored in studies

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What we know

• Overall, elderly population face greater health
  risks from environmental pollution because
• Chronic diseases can be exacerbated by
  environmental contaminants
• Older bodies have less energy/immunity to combat
  environmental hazards
• Some pollutants could accelerate aging
• Older people have collected more toxins in
  their bodies than younger people
• Seniors are more likely to have been exposed to
  toxic chemicals that were previously unregulated

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For example

• Asthma in the US
• Poverty is a strong risk factor for asthma
  mortality
• Majority of the 5000 asthma-related deaths per
  year are among those age 65 and older

Source American Lung Association
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Cost to society

• Strong link between air pollution and increased
  health care cost for older adults
• For every 10 mcg/m3 drop in air pollution
• Medicare will save 76 per person for inpatient
  care
• 100 per person for outpatient care

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Outdoor air

• Few studies of link between outdoor air
  pollution and the health of minority elderly in
  the US
• European study seniors exposed to air
  pollutants for 2 hours showed adverse changes in
  electrocardiogram
• Korean study Rising concentration of
  particulates, CO, SO2, NO2, and O3 resulted in
  increased stroke death

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Outdoor air and disparities

• African-Americans are more likely than Whites to
• Live in households with incomes below the federal
  poverty line
• Have children 5 years of age or younger
• Live closer to the nearest industrial emission
  source
• Live within 2 miles of multiple industrial
  emission source
• Nationwide, 65 of blacks and 80 of Hispanics
  live in counties that do not meet federal air
  pollution standards, compared to 58 of whites.
• No known studies on Asian-Americans and American
  Indians exposure to air pollution
• In general, living in proximity to the sources of
  air pollution lowers environmental quality and
  worsens ones health.

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Why not relocate?

• Not aware of the adverse health effects of
  polluted air
• Acclimated to the polluted air
• Difficult to sell home
• Home prices in area are more affordable
• Uncertain employment opportunities leading to
  unstable income
• Older, retired adults can not afford to move out
  of the area

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Indoor air

• Few indoor air quality studies on older adults
  none focused on the health of geriatric
  minorities
• Elders stay indoors more than younger people.
  Increased risk of exposure to indoor air
  pollutants.
• Smoking and second-hand smoke contribute to all
  major causes of death among the elderly

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How do we fill the knowledge gap?

• RESEARCH!
• Community-based participatory research
• Community empowerment and inclusiveness
• Must involve the community at every level of
  research

How?
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Houston

• is the oil refining and chemical manufacturing
  center of the U.S.
• is one of the most polluted city in the nation
• 120 petrochemical industries
• 11 superfund sites
• 45 hazardous waste sites

• has one of the largest medicals center in the
  world
• has produced no research exploring link between
  air toxics and cancer in Houston
• has grass-roots groups doing independent
  air-quality research

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Addressing environmental issues in Houston

• 1991 The Mickey Leland National Urban Air
  Toxic Research Center
• 2001 NIEHS Baylor College of Medicines
  meeting on environmental health
• 2002 EPA-Region 6 Texas Southern
  Universitys Environmental Justice Listening
  Session
• 2004 IOM Center for Research on Minority
  Healths environmental health workshop

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Expanding the definition of Environmental Health
Built
Social
Natural
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Listening is key to understanding

• Agenda planning based on results from
• Four community focus groups
• One professional focus group
• Advisory panel
  

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Common Environmental Health Concerns in Houston
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Northeast Houston
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Northwest Houston
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Southwest Houston
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Southeast Houston
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Guiding principles

• Coordinate efforts in improving the collection of
  health information for minority communities.
• Research related to health disparities should
  engender three principles
• improve the science base,
• involve the affected populations,
• and communicate the findings to all stakeholders
• Exercise caution on behalf of the affected
  communities, particularly those that have the
  least access to medical, political, and economic
  resources, taking reasonable measures to
  safeguard against or minimize adverse health
  outcomes.

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Recommendations

• Recognize that low-income groups, which include a
  disproportionate number of ethnic and racial
  minorities, constitute a susceptible segment of
  society that deserves special attention and
  protection.
• Advocate for clear state and federal industrial
  emission guidelines and develop enforceable
  standards.
• Encourage research focusing on the specific
  health effects of toxic air exposure.
• Examine air quality and pollution in the context
  of health disparities to include the
  interrelationships among race (disaggregate
  data), age, and poverty. Be inclusive of smaller
  ethnic groups such as Asian Americans and
  American Indians.
• Train minority researchers in the area of
  environmental health disparities using the
  community-based participatory research model.
• Design research projects that are culturally
  competent and linguistically appropriate when
  working with ethnic minority groups. Special
  considerations may be necessary to accommodate
  cognitive needs of the elderly population.
• Educate the community, especially the elderly, on
  the ill effects of air pollution.

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"If you want to change the world, be that
change. Gandhi
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Remember. No matter how hard you work. No
matter how right you are.
Sometimes the Dragon wins However, the object
is not to be eaten so that you can fight on
another day