Chapter Four: Racial, Ethnic, and Gender Disparities in Federal ...
RACIAL AND ETHNIC HEALTH DISPARITIES
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Transcript of RACIAL AND ETHNIC HEALTH DISPARITIES
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RACIAL AND ETHNIC HEALTH DISPARITIES
and the HHS Office for Civil Rights
U.S. Department of Health & Human Services
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Overview
• What are health disparities?
• What is the role of discrimination in health disparities?
• What can the HHS Office for Civil Rights do to reduce health disparities?
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What are “Racial and Ethnic Health Disparities”?
• Differences in rates of diseases• Differences in health outcomes
affecting the health status of certain racial or
ethnic groups
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Differences in rates of disease
Blacks and American Indians have diabetes at higher
rates than Whites
EXAMPLES of Health Disparities
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EXAMPLESof Health Disparities
Differences in outcomes of disease
Compared to Whites, a higher percentage of Black and Native American babies
die in the first year of life
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Differences in outcomes of disease
Black women die of cervical
cancer at twice the rate of White women
EXAMPLESof Health Disparities
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What are “Racial and Ethnic Health Disparities”?
Differences in health care access
and medical treatment
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Differences in access/treatment
In one study -- Minority nursing home patients were less
likely than White patients to receive
medicine for their pain
EXAMPLES
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Differences in access/treatment
Racial minorities are less likely than Whites to
receive certain cardiac diagnostic
procedures
EXAMPLES
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HHS: Addressing Health Disparities
GOALS:• Increase Quality and Years of Healthy Life• Eliminate Health Disparities
www.healthypeople.gov
OCR webpage links to over 20 HHS health disparities initiatives:
http://www.hhs.gov/ocr/healthdisparities.html
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HHS Secretary’s 500-Day PlanCommitment To Transforming
Health Care
In the next 500 days, Secretary Mike Leavitt will concentrate on, in the area of health disparities:
“Supporting community-based approaches to closing the healthcare gap, particularly among racial and ethnic minority populations, including American Indians and Alaska Natives.”
http://www.hhs.gov/500DayPlan/500dayplan.html
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HHS Initiatives to Address Health Disparities
• Closing the Health Gap Initiative and “Take A Loved One to the Doctor” Day
• National Center on Minority Health and Health Disparities (NIH)
• HHS Health Disparities Council• Other HHS health disparities centers
and grant programs at NCI, AHRQ, HRSA, CMS
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HHS Promising PracticesPartnerships with community and faith-
based organizations and with universities, e.g.:
• U. Pitt. Center for Minority Health• Medical University of South Carolina• Laguna Pueblo Community Health
Representatives• Latin American Cancer Research Coalition• People’s Health Center• Vietnamese Reach for Health Initiative
Coalition
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OCR’s Role
HHS-OCR’s responsibility:to enforce Title VI of the Civil Rights Act of 1964 --
as it applies to health care providers who receive federal funds or other
assistance from HHS
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• Tuskegee experiment
• Segregation of medical facilities and health care
providers
LEGACY: DISTRUST AND RELUCTANCE TO SEEK CARE
A Short History of Discrimination in Health Care
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Protects persons of every race, color or national origin from unlawful discrimination
– Race: e.g., Black, White, Asian– Color: skin color, regardless of race– National Origin: ancestry or
ethnicity, can include language proficiency
Title VI of the Civil Rights Act of 1964
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Unlawful Discrimination Title VI
Recipients of Federal financial assistance may not on the basis of race, color, or national origin:
• deny an individual a service, aid, or other benefit
• provide a benefit which is different or provided in a different manner
• subject an individual to segregation or separate treatment
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• Under Title VI, HHS recipients may not:– restrict an individual in the
enjoyment of benefits, privileges– treat an individual differently in
determining eligibility – deny a person an opportunity to participate on a planning or advisory board
Unlawful Discrimination (continued)
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Recipients include:• Hospitals, nursing homes, home
health agencies, managed care organizations
• Health research programs• Physicians, dentists, hospital social
workers, • Other providers who receive Federal
financial assistance from HHS
Who is Covered by Title VI?
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What causesdifferences in
health status?
Discrimination vs. Other Factors Contributing to
Disparities
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Occupation
insufficient education
Heredity
Lifestyle choices
Geographic barriers
Environment
Low income
Reluctance to seek treatment
Inadequate insurance
DISCRIMINATIONDISCRIMINATION
Generally, these are not unlawful discrimination under the enforcement jurisdiction
of OCR
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OCR’sResponsibility:
• Excluding a person, denying them benefits, or otherwise discriminating against them because of their race or some other prohibited reason
DISCRIMINATIONDISCRIMINATION
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May be
• Intentional, or
• Unintentional
DISCRIMINATION
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• Are there neutral reasons for the disparity? e.g., this group of patients doesn’t go to the
doctor because they lack transportation or child care?
or• Did the medical provider treat this
group of patients differently because of their race, color, or ethnicity?
Identifying Discrimination
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• Blacks wait longer to seek medical attention
• Blacks less likely than Whites to receive certain procedures and treatments
Red Flags for Discrimination
Excluding a person, denying them benefits, or otherwise discriminating
against them because of their race, color, or national
origin
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FACT:
In one study, doctors rated Black patients as less intelligent, less educated, more likely to abuse drugs and alcohol, less apt to comply with medical advice, and more likely to lack social support…
… even after their income, education, and personality characteristics were taken into account.
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Discrimination?
• Beliefs or attitudes alone are not discriminatory.
• BUT IF beliefs can be shown to affect the way people are treated, the treatment may be discriminatory.
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FACT:
Among Medicare recipients in managed care health plans, Blacks were less likely to receive:
• Breast cancer screenings• Eye exams when diabetic• Medicine after a heart attack• Follow-up after hospitalization
for mental illness• Flu shots
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Discrimination?
Doctors/HMOs seem to be treating patients differently on the basis of race …
… more investigation would be needed.
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• Asthmatic African-Americans in one health maintenance organization (“HMO”) were less likely than Whites to see specialists and to use inhalers, and were more likely to be hospitalized
• Blacks with diabetes are less likely to get proper medical care than White diabetics
Discrimination?
Possibly.
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What To Do If….
• You believe you or someone else has been discriminated against by a health care provider…..
• You are a health care provider and want help in improving access to your services by racial and ethnic minorities….
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Contact OCR
We can help!
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What Can OCR Do?
• Complaint Investigations• Compliance Reviews • Voluntary Compliance• Technical Assistance
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• Provide information on racial and ethnic health disparities to recipients and other providers upon request
• Refer recipients to quality resources• Review recipient policies and make
suggestions • Make presentations to organizations
What Else Can OCR Do? Technical Assistance
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FOR MORE INFORMATIONFOR MORE INFORMATION
policy guidance fact sheets complaint forms regional office contact
information
Available on OCR’s website:
www.hhs.gov/ocr