Minority Health &Health Disparities

UCSD School of MedicineSandra Daley, M.D.

May 24, 2005

Objectives

Define health disparities Provide evidence of health disparities Describe efforts to reduce health

disparities and describe anticipated outcomes of current efforts

Health Disparities

National Institute of Health “Health Disparities are differences in the incidence,

prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States”

Health and Human Services Agency One of Healthy People 2010’s overarching goals is to

eliminate health disparities.

Leading Health Disparities

Cardiovascular Disease

Cancer Diabetes HIV/AIDS Infant Mortality Asthma Mental Health

National Institute of Medicine Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

Video Module: Worlds Apart

Robert Phillip’s story

Evidence of Racial and Ethnic Disparities in Healthcare

Disparities consistently found across a wide range of disease areas and clinical services

Disparities are found even when clinical factors, such as stage of disease presentation, co-morbidities, age, and severity of disease are taken into account

National Institute of Medicine Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

Across a range of clinical settings including: public and private hospitals teaching and non-teaching hospitals

Disparities in care are associated with higher mortality among minorities (e.g., Bach et al., 1999; Peterson et al., 1997; Bennett et al., 1995)

Evidence of Racial and Ethnic Disparities in Healthcare cont.,

At-risk Populations

Rate of suicide in adolescents has tripled in the last 30 years

In San Diego compared to national data, higher percentage of youth report suicide attempts in the last 12 months (YRBS 2003)

Gay adolescents are 2-3 times more likely than peers to attempt suicide

Self-identified GLB youth are at increased risk for mental and physical health problems (Lock J 1999)

Women are at greater risk for Alzheimer disease than men and are twice as likely as men to be affected by major depression

The Appalachian region suffers an excess in premature deaths (among persons ages 35 to 64) from heart disease, all cancers combined, lung cancer, colorectal cancer, chronic obstructive pulmonary disease, diabetes, and motor vehicle accidents, relative to comparable non-Appalachian U.S. population.

At-risk Populations cont.,

African Americans Experience a more than double infant

mortality rate Have a 30% higher death rate for all

cancers Are more than seven times more likely to

die from HIV/AIDS Are five times more likely to develop the

most common type of glaucoma and are six times more likely to become blind from glaucoma

Hispanics and Latinos

Are almost twice as likely to die from diabetes

Accounted for 20% of new cases of TB, despite only comprising 11% of the population in 1996

Have higher rates of high blood pressure and obesity

American Indians & Alaskan Natives

Have diabetes rates that are more than two times higher

Have disproportionately high death rates from unintentional injuries and suicide

Asian Americans & Pacific Islanders

Have higher rates of new cases of hepatitis and tuberculosis

Demonstrate signs of being a healthy population, on average, but exhibit great diversity within the population. For example, Vietnamese women suffer from cervical cancer at nearly five times the rate of Caucasian women

Disparities in Medical Diagnosis and Treatment Hispanic patients with long bone fractures are

twice as likely as non-Hispanic whites to receive no ED pain medication (Todd et al., 1993).

Black patients with long bone fractures are 1.66 times as likely as non-Hispanic white patients to receive no ED pain medication (Todd et al., 2000).

Blacks are less likely to be referred for cardiac catheterization than whites, despite identical clinical presentations and lab/EKG data (Shulman et al., 1999).

Minorities less likely to be screened for cholesterol levels (Naumburg et al., 1993).

Reasons for Disparities in Health

Explanations for Health Disparities

Methodological differences Data collection

Socioeconomic differences Health services access Education and behavior SES and living/working

environments Biological differences

Anatomical/physiologic Genetic

Explanations for Health Disparities

Sociocultural differences Patient health-related behavior

Diet Substance use Occupation Leisure activity

Professional Competencies Patient Explanatory models

Efforts to Reduce Disparities in

Health

National Institutes of Health (NIH)

New Institute created at NIH: National Center on Minority Health and Health Disparities (NCMHD)

San Diego EXPORT Center

Excellence in Partnerships for Community Outreach, Research on Disparities in Health

and Training

CCOUNCIL OUNCIL CCOMMUNITY OMMUNITY CCLINICSLINICS

OFOF REHDIREHDICounty of San Diego, HHSA

EXPORT Center Goals Promote participation of health disparity groups in

research, prevention, intervention & dissemination activities

Enhance research on HIV and CVD diseases that targets the African American and Latino populations.

Increase number of scientists, graduate & undergraduate students engaged in health disparities research

Disseminate culturally sensitive information on disease prevention in minority communities via clinics and print media network in San Diego

Health Disparities Education San Diego EXPORT Centers HD Education

Core efforts include: Implement a joint minority health disparities

curriculum for UCSD SOM & SDSU graduate students in public health

Develop and propose a new curriculum for medical students with an area of concentration and potential dual degree in Health Equity under the University of California PRIME initiative

University of California’s PRIME

PRIME – Program in Medical Education

To produce culturally & linguistically competent physicians

To train physicians to address the needs of underserved communities

Expanded medical school enrollment with focused programs of excellence & specialized curricula

UCSD’s PRIME-HEq

Program in Medical Education - Health Equity

UCSD PRIME-HEq

Inclusive program that trains physicians to provide better health care services to underserved and at risk populations

Provides a new option for dual degrees in minority health and health disparities

Evolves from community/university partnerships formed over the last two decades

Potential PRIME-HEq Dual Degrees

Public Health

Leadership of Healthcare Organizations

Humanities

Bioengineering

Advanced Studies in Clinical Research

Business Administration

Advanced Studies in Law & Medicine

Benefits of Health Science Pipeline and PRIME-HEq

Attracts a diverse population of highly qualified students

Expands dual degree opportunities

Increases the number of physicians providing services to underserved populations

UCSD Trained Physicians in PRIME

Provide health care to underserved and at risk populations and are excellent clinicians prepared to be:

Physician/Advocates,

Physician/Scholars, and

Physician/Healers

Public & Private Investment to Eliminate Health Disparities Provide latest research-based information

to health care providers to enhance the care provided to populations at risk for health disparities

Introduce science based information into the curricula of medical and allied health professions schools and continuing medical education for health professionals

Establish and maintain ongoing communication and dialogue with underserved populations who experience health disparities

Develop computer databases and internet resources to disseminate current information about scientific research, discoveries and other activities

Develop targeted public health education programs

Objectives

Define health disparities Provide evidence of health disparities Describe efforts to reduce health

disparities and describe anticipated outcomes of current efforts

Questions?

http://meded.ucsd.edu/sdexport