Racial Ethnic Disparities in Health Care

1
Racial / Ethnic Disparities in Health Care

• Primary care is the underpinning of health care
  system
• Percentages of ethnic groups that dont have
  regular doctor
• 30 of Hispanics
• 20 of Black Americans
• Less than 16 of Whites

2
Disparities in Health Care

• Hispanic children are 3X more likely than White
  children to have no usual source of care
• Those that rely on hospitals for primary source
  of care
• 16 of African Americans
• 13 of Hispanics
• 8 of Whites

3
Disparities in Health Care

• Even when insurance companies and incomes are the
  same, minorities receive fewer tests, less
  sophisticated treatments
• African Americans are 13 less likely to undergo
  angioplasty http//www.heartcenteronline.com/myhe
  artdr/Articles_about_the_heart/The_Balloon_Angiopl
  asty_Center.html

4
Disparities, contd.

• If A.A., 1/3 less likely to undergo bypass
  surgery for heart disease
• Children hospitalized for asthma
• 21 of Whites
• 7 of Blacks
• 2 of Hispanics

5
Health Care

• Length of time between mammogram and follow-up
  diagnostic tests for breast cancer are twice as
  long in Asian Americans, Blacks and Hispanics
• African Americans with HIV are less likely to
  receive antiviral therapy / protease inhibitors

6
Health Care

• Asian American, Hispanic and African American
  nursing home residents are less likely to have
  sensory communication aids

7
Insurance issues

• Insurance coverage has declined
  disproportionately affects minorities
• 37 of Hispanic American men are uninsured

8
Why the disparity???
9
Responses to the problem

• Education of physicians!
• Improvement made in teaching hospitals, but not
  non-teaching hospitals

10
Responses, contd.

• Recruitment of minority physicians
• The insurance issue
• Office of Minority Health

11
Office of Minority Health

• Established in 1985 by US Dept of Health and
  Human Services
• Mission
• To improve the health of racial and ethnic
  populations through the development of effective
  health policies and programs that help to
  eliminate disparities in health

12
OMH

• Efforts focused on Federal, State, local health
  programs grants to foster communication among
  agencies Web pages, etc.
• Analogy to Womens Health Initiative

13
Diabetes Mellitus

• Disease that results from hyposecretion or
  hypoactivity of insulin
• Insulin allows cells to take up glucose after
  ingestion of a meal
• No insulin action gt hyperglycemia

14
Diabetes

• Type I diabetes (juvenile diabetes)
• Type II diabetes (non-insulin-dependent diabetes
  mellitus)

15
Type II NIDDM

• Also referred to as adult-onset diabetes
• Almost always associated with being overweight
• Fat cells release tumor necrosis factor-alpha
  (suppresses production of glucose transporter)

16
Type II Diabetes

• Best treatment lifestyle modifications
• Accounts for 90 of all cases of diabetes
• Disproportionately affects nonwhite Americans

17
Long-term health effects of Type II NIDDM

• Cardiovascular and nervous systems affected
• Increased atherosclerosis, risk of heart attack,
  blindness
• Nerve damage gt loss of sensation

18
Type II NIDDM

• Minority populations have higher prevalence of
  type II NIDDM
• Prevalence among American Indians is 2-5 times
  great than Whites
• Black adults are 1.7x more likely to have disease

19
Type II NIDDM

• Mexican-Americans and Puerto Ricans 2x more
  likely to have disease
• Majority of children with type 2 NIDDM are of
  minority groups
• 1/3 of those affected are unaware that they have
  the disease

20
Research goals of OMH

• Prevent or delay onset of type II NIDDM in
  minority populations
• Prevent or delay development of complications in
  minority populations
• Expand education and outreach
• Another area of focus obesity

21
Prostate disease

• Prostate cancer has higher prevalence in African
  Americans
• Disparities in types of therapy? Effectiveness?
  Screening?
• Relationship with benign prostatic hypertrophy
  (BPH)?

22
Environmental Justice

• People of color have been worst victims of
  environmental pollution
• Environmental justice
• is a movement comprising Civil Rights activists
  and environmentalists working to ensure the
  rights of low-income and communities of color to
  clean and healthy environments.
• Hope is to influence environmental policy-making
  to embrace concerns of minorities

23

• Environmental impacts do not fall equally on
  everyone in society. Studies have shown that
  chemical manufacturing plants, hazardous waste
  landfills, highways and other developments with
  negative environmental consequences are more
  likely to be located in low-income and minority
  communities.