Health Disparities of People with Disabilities;Influence of Race and EthnicityNCIL ConferencePresenters;Dara BaldwinStanley Holbrook

Health Disparities Overall, people with disabilities have been

reported to experience fair or poor health, approximately four times more than their non-disabled peers. In addition, there is a disproportionate percentage of people with disabilities that experience the social determinants of poor health

Health Disparities• In addition, there is a disproportionate

percentage of people with disabilities that experience the social determinants of poor health

Health Disparities In spite of startling evidence of health disparities

among people with disabilities and the inherent costs to treat preventable conditions, current federal law does not consider individuals with disabilities a “medically underserved population.”

Health Disparities• It also does not include disabilities under

requirements for cultural competence and fails to recognize disability health disparities under any federal program that addresses health disparities.

Why is this Important? Why is this important? Achieving optimal health is a goal for

everyone. Health disparities exist for persons with disabilities, in part due to insufficient information about and available services for wellness promotion.

Why is this Important? Persons with disabilities, as all persons

seeking health care and wellness services, benefit from access to care providers who have the knowledge and skills to address the full range of their health concerns, including their special needs.

Why is this Important? “Health” has the same meaning for

persons with and without disabilities. Disability itself is not an illness, and people living with disabling conditions can be healthy despite the disease or disorder causing the impairment. Being healthy includes having the knowledge and tools to promote wellness and prevent illness

Why is this Important? We know that people with disabilities as

a whole have a greater prevalence and more complex mix of multiple chronic conditions than people without disabilities

Why is this Important? It is our right to have equal access to

good health, opportunities, housing, employment, etc.

Overview• This presentation will cover;

The Levels of Health Care Interventions The difference between Heath Disparity and

Health Equity The Prevalence of Disability, Poor Health, and

Incidence of Chronic Conditions Influence of Race and Ethnicity Opportunities

Levels of Intervention Three Levels of Health Intervention

Accessing/addressing the lack of culturally and linguistically appropriate Health Services

Addressing the Social Determinants of Health Addressing the Social Determinants of Equity

Levels of Intervention Addressing the Lack of appropriate

Health Services Limited access to health care impacts

people's ability to reach their full potential, negatively affecting their quality of life.

Access to Health Care Barriers to services include:• Lack of availability• High cost• Lack of insurance coverage

Access to Health Care• These barriers to accessing health services lead

to: Unmet health needs Delays in receiving appropriate care Inability to get preventive services Hospitalizations that could have been prevented

Social Determinants of Health Social Determinants of Health The social determinants of health are the

circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.

Social Determinants of Health Also known as social and physical determinants of

health, they impact a wide range of health, functioning and quality of life outcomes.

Social Determinants of Health Social Determinants Examples of social determinants include:• Availability of resources to meet daily needs, such as

educational and job opportunities, living wages, or healthful foods

• Social norms and attitudes, such as discrimination• Exposure to crime, violence, and social disorder, such as the

presence of trash• Social support and social interactions• Exposure to mass media and emerging technologies, such as

the Internet or cell phones

Social Determinants Social Determinants• Socioeconomic conditions, such as concentrated

poverty• Quality schools• Transportation options• Public safety• Residential segregation

Physical Determinants• Natural environment, such as plants, weather, or

climate change• Built environment, such as buildings or transportation• Worksites, schools, and recreational settings• Housing, homes, and neighborhoods• Exposure to toxic substances and other physical hazards• Physical barriers, especially for people with disabilities• Aesthetic elements, such as good lighting, trees, or

benches

Social Determinants of Health

Addressing the Social Determinants of Health

Involves the medical care and public health systems, but clearly extends beyond these

Requires collaboration with multiple sectors outside of health, including education, housing, labor, justice, transportation, agriculture, and environment

Social Determinants of Equity Axes of Inequity include;

Race Gender Ethnicity Disability status Labor roles Social Class

Social Determinants of Equity Differences in access to goods,

services and opportunities Examples include;

Housing Education Employment Income Medical Facilities

Social Determinants of Equity Examples;

Living Environment Information/Resources Voice to be heard

Inequity leads to self devaluation Unfair advantage to some Unfair disadvantage to others

Social Determinants of Equity Racism is the crux of inequity

Racism – is speaking of a system of power, a system of structuring opportunity and assigning value based upon the social interpretation of how we look

Social Determinants of Equity Racism Unfairly disadvantages some individuals

and communities, while unfairly giving advantages to other individuals and communities

Social Determinants of Equity Two Levels of Racism

Institutionalized Racism – provides differences of access to goods and services

Internalized racism – acceptance by those stigmatized of negative messages about their own abilities

Social Determinants of EquityAddressing Social Determinants of Equity

Involves monitoring for inequities in exposures and opportunities, as well as for disparities in outcomes

Involves examination of structures, policies, practices, norms, and values

Requires intervention on societal structures and attention to systems of power

Health Disparities/Health Equity Health Disparity

• Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”2

• http://www.healthypeople.gov/hp2020/advisory/PhaseI/sec4.htm#_Toc211942917. Accessed 4/26/13.

Health Disparities/Health Equity Health Equity Healthy People 2020 defines health equity as the

“attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”2

• http://www.healthypeople.gov/hp2020/advisory/PhaseI/sec4.htm#_Toc211942917. Accessed 4/26/13.

Health Disparities/Health Equity While we will address disparate health, our focus

should always be on obtaining health Equity

Health Equity and InequityHealth equity is achieved when all people have the opportunity to be as healthy as possible and no one is limited in achieving good health because of their social position or any other social determinant of health. Health inequity results when disparities or differences are combined with conditions that are unfair, unjust and avoidable.

Health Equity and Inequity As we move forward we must; Address the social determinants of health,

including poverty, in order to achieve large and sustained improvements in health outcomes

•Address the social determinants of equity, including racism, in order to achieve social justice and eliminate health disparities

Health Equity and Inequity Until we solve the problem of equity, there will

always be some form of disparity

If we take care of the problem of the Social Determinants of Equity, the other health interventions (Social determinants of health and equal access) will fall in place

Prevalence of Secondary Conditions for PWD Individuals with Disabilities are more likely to

experience early death, chronic conditions, and preventable health conditions

•Individuals with disabilities experience higher incidence of obesity, osteoporosis, diabetes, high blood pressure, and oral disease.

Prevalence of Secondary Conditions for PWD•Research shows that individuals with disabilities experience greater unmet health needs than the non-disabled population and receive fewer routine and preventative services such as blood pressure checks, and cholesterol and cancer screenings.

Influence of Race and Ethnicity African-Americans have a higher rate of disability

than their prevalence in the general population would suggest (15.8%).

They are significantly more likely to have hypertension (43.8%), diabetes (13.9%), and obesity (39.9%) than Caucasian adults with disabilities (28.0%, 7.6%, and 22.8%) than Caucasian adults with disabilities (28.0%, 7.6%, and 22.8% respectively)

Influence of Race and Ethnicity• African Americans with disabilities have the

highest rate of unemployment African Americans with disabilities have the 2nd

highest prevalence of fair or poor healthIn the multivariate analyses, African-Americans with disabilities had twice the odds of having hypertension and diabetes, and 1.5 times the odds of having obesity, as Caucasians with disabilities did.

Influence of Race and Ethnicity There is an intersection between minority status

and ethnicity that African Americans/Hispanics etc. have referred to “double jeopardy” that increase the likelihood of inadequate healthcare and cultural bias

This status does not only effect African Americans with Disabilities, but other persons of color as the next few slides will project.

Double Jeopardy

Person withA Disability

DoubleJeopardy

MinorityStatus

Influence of Race and Ethnicity

Prevalence of Disability by Race – Adults 18 Years of Age and Older2009 Prevalence

Influence of Race and Ethnicity

Racial/Ethnicity % Employed % unemployed % not in the labor force

Total, age>=16 years

58.5% 9.6% 36.3%

Disability 18.6% 14.8% 78.2%

White 19.3% 13.6% 77.6%

Black/African American

13.8% 22.00% 82.3%

Asian 16.0% 12.0% 81.7%

Hispanic/Latino 19.0% 18.4% 76.7%

No Disability 63.5% 9.4% 29.9%

White 64.6% 8.5% 29.4%

Black 57.4% 15.8% 31.9%

Asian 62.5% 7.4% 32.5%

Hispanic/Latino 62.4% 12.3% 28.9%

Table 1. Percentage employment status of the civilian non institutional population by disability status and race/ethnicity, 2010 Annual averages Population > = 16 years, US Department of Labor BLS, 2010

Influence of Race and Ethnicity

Race/Ethnicity % with a Disability

% with a Disability

reporting Fair or Poor Health

% without a Disability

reporting Fair or Poor Health

White 21.6 36.4 5.8

Black/African American

22.6 47.6 13.4

Hispanic/Latino 17.5 54.1 23.2

Asian 10.5 31.5 8.5

Nat. Haw./Pac. Island

17.9 47.6 13.4

Multi-Race 30.6 45.3 9.6

Total 21.1 40.0 9.2

Source: Centers for Disease Control and prevention, CDC Health Disparities and Inequalities Report-United States 2011; Rationale for regular reporting on health disparities and Inequalities-United States, MMWR 2011 (Suppl):3-10.

Table 2: Disability Prevalence by Race/Ethnicity and Percentage with Fair or Poor Health

Influence of Race and EthnicityPrevalence of Chronic Conditions

Adapted from: Jones, GC. (Dec-2005) Health disparities among African-Americans with disabilities: Implications for evidence-Based Health Promotion. Philadelphia, PA. American Public Health Association 133rd Annual Meeting & Exposition.

Opportunities What can Centers for Independent

Living do?

CIL Opportunities Pay attention Educated yourself and consumers

concerning health care access, secondary and chronic conditions

Be a resource that empowers persons with disabilities to be able to begin to manage their health needs

CIL Opportunities Work to become Culturally and

Linguistically Competency The Demographic of the US is changing. Funding is continually

decreasing/competition is increasing To remain viable CIL’s must be able to

“serve everyone who walks through the door.”

Health Promotion and Wellness Model Living Well with a Disability

Program (U of Montana) Offers self help model promoting Health

and Wellness of Consumers. Highly successful

For Information contact Tracy Boehm, MPH at 406-243-5741boehm@ruralinstitute.umt.edu

Advocacy Centers should advocate for:•Access to quality care by health care providers trained to treat individuals with disabilities, including intellectual and other disabilities; Inclusion of individuals with disabilities in the definitions of “medically underserved populations” and “cultural competence;”

Advocacy•A healthcare workforce trained to address the needs of individuals with disabilities, including physical, mental health, cognitive, sensory, intellectual, and/or developmental disabilities;

Advocacy•Inclusion of “disabilities” and “sign language interpreters” in the Office of Minority Health’s National Standards on Culturally and Linguistically Appropriate Services (CLAS)

AdvocacyA delivery system prepared to provide appropriate, accessible, and equivalent care for all individuals with disabilities at all levels of service;

Advocacy/Opportunities Know and Advocate for enforcement of

the following provisions written in the ACA

Centers may be able to find a role I/R, Health Navigator, Disease State

management There are provisions written within the

ACA that can provide a foundation to health care access

ACA/OpportunitiesSection 4302 of the Affordable Care Act includes provisions to invest in the improvement of health data collection and analysis strategy to capture information such as race, ethnicity, and disability status. Health reform must end these health disparities by ensuring:

ACA/Opportunities

Health reform must end these health disparities by ensuring:• Access to affordable coverage for Americans with

all forms of disabilities without regard to pre-existing conditions

Inclusion of individuals with disabilities in the definition of “medically underserved populations” and “cultural competence”

ACA/Opportunities• Inclusion of individuals with disabilities in all data

collection and reporting required for racial, ethnic, gender, or geographic health disparities in a manner than can facilitate identification and reduction of disparities associated with all forms of disabilities

ACA/Opportunities• Equal treatment of the population of individuals

with disabilities in all policies, programs, and research designed to decrease health disparities

Inclusion of individuals with disabilities in prevention and wellness programs

Questions Stanley Holbrook sholbrook@trcil.org Dara Baldwin daraldb@gmail.com

Thank you!!