Introduction to Public Health : Minority Health MPH 600 Guest Lecturers

1
Introduction to Public Health Minority Health
MPH 600Guest Lecturers

• L. Robert Bolling, Former Director
• Henry C. Murdaugh, Director
• For Christopher Buttery, MD, MPH

2
Minority Populations Demographics

• Racial and Ethnic Minorities Comprise 24 of the
  states total population
• African-Americans/Blacks 1.5 million (20)
• Asian/Pacific Islanders 248,00,000 (3.6)
• Hispanics/Latinos 251,000 (3.7)
• Native Americans -- 19,000 (lt1)

3
Background

• 1985 Report of the U.S. Secretary of Health and
  Human Services Task Force on Black and Minority
  Health.
• Virginia Minority Health Initiative.

4
Virginia Minority Health Initiative

• Minority Health Advisory Committee
• Provides --
• Recommendations and information for improving
  minority health to the Commissioner, VDH, and
  other agencies and organizations.

• Office of Minority Health
• Provides --
• Policy development
• Resource development
• Data/Information
• Technical Assistance

5
Virginias African-American Health Status

• Available data for Virginia shows a substantial
  disparity or gap between health indices for
  Blacks and Whites.

6
Virginias African-American Health Status
Indicators

• Life expectancy, infant mortality, low birth
  weight and teenage pregnancy are considered
  reliable indicators or measures of health status
  and quality of life.
• The burden of chronic disease provides another
  reliable index for measuring health status.

7
The Disparity or Gap(Adults)

• Heart Disease
• Cancer
• Cerebrovascular Disease/Stroke
• Diabetes
• Unintentional Injuries
• HIV/AIDS
• State Health Commissioner's Minority Health
  Advisory Committee, Initial Fact Sheet, 1990

8
Comparison of Life Expectancy by Race, Virginia,
1992

• Black life expectancy is six years less than for
  whites.
• Race Years
• Black 71
• White 77
• Total 75
• Rounded to the nearest year, Center for Health
  Statistics, Virginia Department of Health

9
Comparison Heart Disease Mortality Rate by Race
(age-adjusted/100,000 pop) Virginia, 1995

• POP RATE
• Black 186.7
• White 127.8
• Total 137.6
• HP 2K (Black) 115.0
• HP 2K (All) 100.0
• Source Virginias Plan for Cardiovascular
  Disease Prevention, 1998-2000

10
Comparison Breast Cancer Incidence and Mortality
Rates, By Race (age-adjusted/100,000
pop)Virginia, 1994

• Although the incidence of breast cancer is
  comparable across racial populations in
  Virginia, the Black death rate doubles the white
  rate.
• Race Incidence Rate
• Black 94.5 29.6
• White 98.1 15.3
• Total 97.5 21.5
• HP 2K (Black) 25.0
• HP 2K (All) 20.6
• Source Breast and Cervical Program, VDH

11
Comparison Stroke Mortality Rates by Race
(age-adjusted/100,000 pop) Virginia, 1994

• POP RATE
• Black 48.2
• White 25.7
• Total 29.7
• Source Virginias Plan for Cardiovascular
  Disease Prevention, 1998-2000

12
Comparison of Diabetes-Related Mortality
(age-adjusted) by Race, Virginia, 1996

• RATE
• Black 74.4
• White 31.2
• Total 37.8
• Source Diabetes Control Surveillance Project,
  Survey and Evaluation Research Laboratory,
  Virginia Commonwealth University, 1998

13
The Disparity or Gap (Children)

• Infant Mortality
• Low Birth Weight
• Teenage Pregnancy
• Lead, Asthma
• Tobacco Use

14
Infant Mortality Rate per 1,000 Live Births
Virginia, 1991-1998
Source Center for Health Statistics
15
Resident Low Weight Live BirthsPercent of Total
Live BirthsVirginia, 1991-1998
Source Virginia Center for Health Statistics
16
Resident Teenage PregnanciesVirginia, 1976-1998
Source Virginia Center for Health Statistics
17
Childhood Lead Poisoning per 100,000 Children
Aged 0-15 By Race
Black children are 9.7 times more likely to have
lead poisoning than white children.
18
Reported HIV and AIDS Cases By Race, 1990 to
1997 (Percentage)
19
Total Syphilis Cases and Racial Percentage,
1990-1997

• Year Cases Black
• 1990 1,551 91.6
• 1991 1,622 90.5
• 1992 1,347 92.2
• 1993 1,268 91.3
• 1994 1,409 90.3
• 1995 1,144 91.4
• 1996 798 90.9
• 1997 615 88.1

20
African-Americans Eligible for Medicaid, 1996
The Statistical Record of the Virginia Medicaid
Program, October 1996
21
Percent of Total Uninsured by Race, Virginia 1993
and 1996
JCHC Staff Analysis 93 96 Health Care Access
Surveys
22
Percent of African-Americans by Type of Insurance
Status
JCHC Staff Analysis 93 96 Health Care Surveys
23
Vignettes

• 39 yr old Honduran pregnant mother
• Employed as housekeeper in local hotel
• No insurance
• Limited English Proficiency
• Goes to local for profit hospital
• Blood in stool

• 54 yr old African-American married male
• Diabetic on insulin
• Slightly overweight
• Manager at local factory
• Insured
• Blood in stool

24
Discussion Questions?

• Is there a difference between community health
  and minority health?
• How can we eliminate health disparity in access
  to health care?
• How is access to health care for minority and
  underserved populations financed in Virginia?

25
Models that Work

• Virginia Baptist General Convention Collaborative
  project with the Virginia Department of Health
• African-American Fatherhood Campaign
• Alliance of Black Churches

26
Why Do these Programs Work?

• Adequately Funded Federal, State, Local and
  Privately
• Community-Based
• Culturally Competent
• Accessible

27
Effective Strategies to Improve Minority Health

• Support and Collaborate with Your State Offices
  of Minority Health
• Establish National Umbrella Advocacy Organization
  with Sole or Primary Focus on African-American
  Health Issues
• Partnership with Other Minority Health Entities
• Promote State Legislation Action to Address
  Minority Health

28
Be Active Now Each One, Reach One

• Tsamaya Sentle!