How Covid-19 Has Exacerbated Healthcare Disparities Among ... bipoc health... · the District of...
Transcript of How Covid-19 Has Exacerbated Healthcare Disparities Among ... bipoc health... · the District of...
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How Covid-19 Has Exacerbated Healthcare
Disparities Among BIPOC
S. Michelle Ogunwole, MD
@DrChelleMD
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Goals of the Session
• Describe racial disparities in COVID-19 health outcomes
• Evaluate drivers of COVID-19 related health and healthcare disparities
• Discuss emerging information about COVID-19 and the importance of continued
vigilance
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Road Map: 3 Phases of Disparities ResearchD
ete
ctin
g Define health disparities
Define vulnerable populations
Measure disparities in vulnerable populations
Consider selection effects and confounding factors
Un
de
rsta
nd
ing Identifying determinants of health disparities at the following levels:
Patient / individual
Provider
Clinical encounter
Health care system
Re
du
cin
g Intervene
Evaluate
Translate and disseminate
Change Policy
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Early on, many states missing race/ethnicity
data on COVID-19 cases
Data from the COVID Tracking
Project as of 5 p.m. on May 6. For
states that reported both race and
ethnicity data, race data was used.
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States that have released breakdowns of Covid-19 data by
race in the testing category (as of July 4th)
4 States:
• Delaware
• Illinois
• Kansas
• NevadaThis map shows the U.S. states that have released
COVID-19 data by race, broken down into three
critical categories: confirmed cases, deaths, and
testing.Source: coronavirus.jhu.edu/data/racial-data-
transparency
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States that have released breakdowns of Covid-19 data by race
in the confirmed cases category (as of July 4th)
47 States:• Alabama
• Alaska
• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• District of Columbia
• Florida
• Georgia
• Hawaii
• Idaho
• Illinois
• Indiana
• Iowa
• Kansas
• Kentucky
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Mississippi
• Missouri
• Montana
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• North Carolina
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• Rhode Island
• South Carolina
• South Dakota
• Tennessee
• Texas
• Utah
• Vermont
• Virginia
• Washington
• West Virginia
• Wisconsin
• Wyoming
This map shows the U.S. states that have released COVID-19 data by
race, broken down into three critical categories: confirmed cases,
deaths, and testing.
Source: coronavirus.jhu.edu/data/racial-data-transparency
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States that have released breakdowns of Covid-19 data by race in
the death category (as of July 4th)
45 States:• Alabama
• Alaska
• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• District of Columbia
• Florida
• Georgia
• Idaho
• Illinois
• Indiana
• Iowa
• Kansas
• Kentucky
• Louisiana
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Mississippi
• Missouri
• Nevada
• New Hampshire
• New Jersey
• New York
• North Carolina
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• Rhode Island
• South Carolina
• Tennessee
• Texas
• Utah
• Vermont
• Virginia
• Washington
• West Virginia
• Wisconsin
• Wyoming
This map shows the U.S. states that have released COVID-19 data by
race, broken down into three critical categories: confirmed cases,
deaths, and testing.
Source: coronavirus.jhu.edu/data/racial-data-transparency
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Racial disparities in COVID 19
• Aggregated death rates from
COVID-19 across all states and
the District of Columbia have
reached new highs for all groups:
• The latest overall COVID-19
mortality rate for Black
Americans is 2.3 times as
high as the rate for Whites
and Asians, and 2.2 times as
high as the Latino rate.
1 in 3,800
White Americans has died
(or 26.2 deaths per 100,000)
1 in 3,800
Asian Americans has died
(or 26.3 deaths per 100,000)
1 in 3,550
Latino Americans has died
(or 28.2 deaths per 100,000)
1 in 1,625
Black Americans has died
(or 61.6 deaths per 100,000)
1 in 2,775
Indigenous Americans has died (or
36.0 deaths per 100,000)
Black
Indigenous
White
Latino
Asian
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Black Indigenous Latino Asian White
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COVID-19 deaths per 100K people of each group,
through June 9, 2020
* Includes all available data from Washington D.C., and
the 50 states. Users are cautioned that the Indigenous
rate is calculated from just 21 reporting states. States
employ varying collection methods regarding ethnicity
data. Denominator is built from data aggregated from
each state aligned with their method.
All deaths with
known race
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Road Map: 3 Phases of Disparities ResearchD
ete
ctin
g Define health disparities
Define vulnerable populations
Measure disparities in vulnerable populations
Consider selection effects and confounding factors
Un
de
rsta
nd
ing Identifying determinants of health disparities at the following levels:
Patient / individual
Provider
Clinical encounter
Health care system
Re
du
cin
g Intervene
Evaluate
Translate and disseminate
Change Policy
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Racial Disparities in Chronic Disease
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Source: https://medicalxpress.com/news/2020-04-chronic-
conditions-worsen-coronavirus-pandemic.html
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Social Determinates of Health
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Racism
Source: https://blogs.umass.edu/comm397ss-jsaxe/class-map-youth-systemic-racism/
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Source:
https://www.visualcapi
talist.com/wp-
content/uploads/2020
/04/covid-19-
occupational-risk-
scores.html
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Racism
https://blogs.umass.edu/comm397ss-
jsaxe/class-map-youth-systemic-racism/
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The Pandemic is not over:
here is what we know
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World’s worst outbreaks
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The US is not Like Other Developed Nations
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New trend: increase in cases among younger people
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Young + Chronic Disease + Social Risk
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Long road ahead: Stay Vigilant!
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THE THM
• Racial disparities in COVID-19 exist: BIPOC are at highest risk of infection and death
• The root cause of racial disparities are rooted in social and structural inequity
• The Pandemic is NOT OVER:• Wear a mask, wash your hands,
avoid large gatherings if you can
• Ask for help
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Trauma Informed Care in a Time of Crisis
Danica Love Brown, MSW, CAC III, PhD
(Choctaw Nation of Oklahoma)
Behavioral Health Manager
Northwest Portland Area Indian Health Board
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Trauma Informed Care
• TIC is a strengths-based service delivery approach that is rooted in an understanding of
and responsiveness to the impact of trauma, that emphasizes physical, psychological,
and emotional safety for both providers and clients.
• Hopper, Bassuk, & Olivet, 2010
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Principles of Trauma Informed Care
• TRAUMA
• LANGUAGE ACCESS & CULTURAL SENSITIVITY
• SAFETY
• TRUSTWORTHINESS
• CHOICE
• COLLABORATION
• EMPOWERMENT
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Trauma
• Is an extraordinary psychological experience
caused by treats to life and body or personal encounters with violence or death
• Disasters: natural
• Atrocities: human
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Types of Trauma
• Acute trauma
• Repetitive trauma
• Complex trauma
• Developmental trauma
• Vicarious trauma
• Cultural, Historical and/or Intergenerational trauma
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Mechanisms by Which Adverse Childhood Experiences
Influence Health and Wellbeing Throughout the Lifespan
Early Death
Disease and Disability
Adoption of Health-risk Behaviors
Social, Emotional, and Cognitive Impairment
Disrupted Neurodevelopment
Adverse Childhood Experience
Death
Conception
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Stress
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ANCIENT SURVIVAL RESPONSES
TO LIFE THREATENING CIRCUMSTANCES
• What is your go to survival response?
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What do we do?• Increase Sense of Safety
• Reduce anxiety with healthy actions that make you feel safer.
• Stay Connected
• Seek support from family, friends, mentors, clergy, and those who are in similar
circumstances.
• Be flexible and creative in accessing support via phone, email, text messaging, and
video calls
• Improve Your Sense of Control and Ability to Endure
• Accept circumstances that cannot be changed and focus on what you can alter.
• Modify your definition of a "good day" to meet the current reality of the situation.
• Cultivate Ways to be More Calm
• Mindfulness can be really helpful to reset your nervous system
• Remain Hopeful
• U.S. Department of Veterans Affairs, PTSD: National Center for PTSD
https://www.ptsd.va.gov/covid/COVID_managing_stress.asp
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Summary
• Trauma-informed care begins with understanding the trauma-informed brain.
• Prevalence of traumatic histories is very high among individuals involved with mental
health, social service, substance-use, & criminal justice systems.
• Trauma-anchored responses are learned adaptations for survival.
• Re-experiencing & re-enactment is frequent in service settings and is out of the
individual’s awareness.
• Key to successful interventions is reduction of possible reminders/threat cues.
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Contact Us Mental Health America
500 Montgomery Street
Suite 820
Alexandria, VA 22314
/mentalhealthamerica
@mentalhealtham
@mentalhealthamerica
/mentalhealtham
/mentalhealthamerica
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• For certificates of attendance please
email [email protected]
• We do NOT offer CEUs