Social Factors Matter

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Social Factors Matter. Class, Race and Gender in Health Outcomes. Important Points to Consider. Social class (which relates to occupation) is the most important predictor of health outcomes. Rates of disease and death differ between regions of the world. - PowerPoint PPT Presentation

Transcript of Social Factors Matter

  • Social Factors MatterClass, Race and Gender in Health Outcomes

  • Important Points to ConsiderSocial class (which relates to occupation) is the most important predictor of health outcomes.

    Rates of disease and death differ between regions of the world.

    Racism of health professionals explains differences in health care between whites and minorities.

    Sexism leads to higher rates of death among women with respect to heart disease.

  • Differences between the wealthy and poor nations in the worldChildren in poorer nations have a higher risk of dying than in wealthier nations.98% of child deaths (10.5 million) occur in the poorer nations of the world.Life expectancy and mortality figures have gotten worse in the past ten years for Africa.

  • Infectious and parasitic diseases are the main causes of death in poorer nationsAdults tend to die of non-communicable diseases in the richer nations (9 of 10 people).

    Poorer nations of Latin America, Asia and the Western Pacific see 3 out of 4 deaths from non-communicable diseases.

    In Africa only 1 in 3 deaths result from non-communicable disease.80% of the nearly 3 million deaths from AIDS occur in sub-Saharan Africa.

  • Leading causes of death in children in developing countries 1 Perinatal conditions 2 Lower respiratory infections 3 Diarrhoeal diseases 4 Malaria 5 Measles 6 Congenital anomalies 7 HIV/AIDS 8 Pertussis (whooping cough)9 Tetanus 10 Protein-energy

  • Class and HealthPeople in lower classes tend to have more health problems including psychiatric disorders

    Disparity in wealth and health is getting worse

    Employees within the same firm will have health outcomes consistent with their rank in the firm

  • Class Matters: Heart Attacks, and What Came Nexthttp://www.nytimes.com/indexes/2005/05/15/national/class/

  • Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare

    Institute of Medicine

  • Access (e.g., insurance status, ability to pay for healthcare) is the most important predictor of the quality of healthcare across racial and ethnic groups

    It is difficult even artificial to separate access-related factors from social categories such as race and ethnicity

    The bulk of research on healthcare disparities has focused on black-white differences more research is needed to understand disparities among other racial and ethnic minority groups

    Caveats Unequal Treatment

  • Non-MinorityMinorityDifferenceClinical Appropriateness and Need Patient Preferences The Operation of Healthcare Systems and the Legal and Regulatory Climate Discrimination: Biases andPrejudice, Stereotyping, andUncertaintyDisparityQuality of Health CareFigure 1: Differences, Disparities, and Discrimination: Populations with Equal Access to Health CarePopulations with Equal Access to Health Care

  • Evidence of Racial and Ethnic Disparities in HealthcareDisparities 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

    Disparities are found across a range of clinical settings, including public and private hospitals, teaching and non-teaching hospitals, etc.

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

  • What is the Evidence that Physician Biases and Stereotypes May Influence the Clinical Encounter?van Ryn and Burke (2000) - study conducted in actual clinical settings found that doctors are more likely to ascribe negative racial stereotypes to their minority patients. These stereotypes were ascribed to patients even when differences in minority and non-minority patients education, income, and personality characteristics were considered.

    Finucane and Carrese (1990) - Physicians more likely to make negative comments when discussing minority patients cases.

  • What is the Evidence that Physician Biases and Stereotypes may Influence the Clinical Encounter (contd)?Rathore et al. (2000) found that medical students were more likely to evaluate a white male patient with symptoms of cardiac disease as having definite or probable angina, relative to a black female patient with objectively similar symptoms.

    Abreu (1999) found that mental health professionals and trainees were more likely to evaluate a hypothetical patient more negatively after being primed with words associated with African American stereotypes.

  • Among Medicare Beneficiaries Enrolled in Managed Care Plans, African Americans Receive Poorer Quality of Care (Schneider et al., JAMA, March 13, 2002

  • What are potential sources of disparities in care?Health systems-level factors financing, structure of care; cultural and linguistic barriers

    Patient-level factors including patient preferences, refusal of treatment, poor adherence, biological differences

    Disparities arising from the clinical encounter

  • Differences are RealPhysicians hold stereotypes that affect treatment

    Differences in treatment and outcome CANNOT be explained away by other factors

    Bias and racism lead to real differences in the treatment and outcome of minorities

  • The National Coalition for Women with Heart Disease 38% of women and 25% of men will die within one year of a first recognized heart attack.

    35% of women and 18% of men heart attack survivors will have another heart attack within six years.

    46% of women and 22% of men heart attack survivors will be disabled with heart failure within six years.

    Women are almost twice as likely as men to die after bypass surgery.

    Women are less likely than men to receive beta-blockers, ACE inhibitors or even aspirin after a heart attack.

  • More women than men die of heart disease each year,yet women receive only:

    33% of angioplasties, stents and bypass surgeries 28% of inplantable defibrillators and 36% of open-heart surgeries

    Women comprise only 25% of participants in all heart-related research studies.

  • Important Points to ConsiderSocial class (which relates to occupation) is the most important predictor of health outcomes.

    Rates of disease and death differ between regions of the world.

    Racism of health professionals explains differences in health care between whites and minorities.

    Sexism leads to higher rates of death among women with respect to heart disease.