Disparities Final 131125 7

HEALTH DISPARITIES IMPACTING RACIAL AND ETHNIC MINORITIES IN MICHIGAN: 

HEALTH DISPARITIES IMPACTING RACIAL AND ETHNIC MINORITIES IN MICHIGAN CONTRIBUTORS: BUREAU OF EPIDEMIOLOGY BUREAU OF FAMILY, MATERNAL, AND CHILD HEALTH DIVISION OF CHRONIC DISEASE AND INJURY CONTROL DIVISION OF HEALTH, WELLNESS AND DISEASE CONTROL

To increase awareness of health disparities by collecting and disseminating relevant dataDecrease the burden of disparities by distributing information on public health interventions with proven effectivenessEstablish a systematic approach to collaboration and communication among governmental, private and community based health entitiesLeverage resources to initiate new and innovative programs: 

To increase awareness of health disparities by collecting and disseminating relevant data Decrease the burden of disparities by distributing information on public health interventions with proven effectiveness Establish a systematic approach to collaboration and communication among governmental, private and community based health entities Leverage resources to initiate new and innovative programs Purpose of Health Disparities Initiatives

Elimination of Health Disparities: 

“The test of progress is not whether we add more to the abundance of those who have much, it is whether we provide enough for those who have little” Franklin Delano Roosevelt Elimination of Health Disparities Became significant concern in 1998 Six health categories: adult immunization, cardiovascular care, cancer care, diabetes, HIV/AIDS and infant mortality

What is a Health Disparity?: 

What is a Health Disparity? Health: A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (World Health Organization) Disparity: A chain of events signified by a difference in (1) environment; (2) access to, utilization of, and quality of care; (3) health status; or (4) a particular health outcome that deserves scrutiny. Carter-Pokras & Baquet, Public Health Reports, Sept/Oct, 2002

Health Disparities: 

Health Disparities Disparities in health, which refer to differences in health outcomes and status; and Disparities in health care, which refer to differences in the preventative, diagnostic and treatment services offered to people with similar health conditions, as well as, health care access.

Contributing Factors: 

Contributing Factors Poverty Education Level Cultural Attitudes, Norms, and Values Minority Mistrust of Healthcare System Language

Contributing Factors (cont.): 

Contributing Factors (cont.) Provider Cultural Competency “Health is really a social transaction that has a scientific base. You need to have doctors who have the basic knowledge, but that alone is not enough. You have to have a physician that is able to communicate in a way a patient understands.” Dr. Louis Sullivan, former U.S. Secretary of Health and Human Services Stereotypes held by Healthcare Providers Access to Health Care

Contributing Factors (Continued): 

Contributing Factors (Continued) ACCESS to Health Care 45.8 million Americans (15.7% of the total population) lacked health insurance in 2005. 7.8% of Michigan residents, or almost 800,000 people are insured at any one time. Minorities are more likely than whites to be uninsured 32.7% of Hispanics are uninsured 29.9% of Native Americans and Alaska Natives are uninsured 19.6% of African-Americans are uninsured 17.9% of Asians are uninsured 11.3% of white non-Hispanics are uninsured State Planning Project for the Uninsured 2005; U.S. Census Bureau 2005

Slide9: 

“The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadows of life, the sick, the needy and the handicapped” Hubert H. Humphrey

Disparities Across the Spectrum: 

Disparities Across the Spectrum Infant Mortality Black infant deaths occur almost 3 times more often than White infant deaths Prostate Cancer Black male deaths occur 2 times more often than White male deaths HIV/AIDS The rate of HIV infection among Blacks is over 8 times higher than the rate among Whites Source: Vital Records & Health Data Development Section, Michigan Department of Community Health

Demographic Profile: 

Distribution of Michigan's Population by Race/Ancestry Demographic Profile

Michigan Life Expectancy: 

White males White females Black males Black females Michigan Life Expectancy 1950 2005 66.2 60.4 71.9 63.4 75.8 68.0 80.1 75.1 Source: Vital Records & Health Data Development Section, Michigan Department of Community Health

Slide13: 

Percent Surviving to 65 (2003): White Female 88.0 White Male 81.5 Black Female 76.9 Black Male 63.4 Age Percent Survival Survival Curve Ages 15-75 by Sex and Race, Michigan Residents, 2005 Source: Vital Records & Health Data Development Section, Michigan Department of Community Health

Racial and Gender Disparities in Selected Risk Factors for Chronic Disease, Michigan, 2005: 

Racial and Gender Disparities in Selected Risk Factors for Chronic Disease, Michigan, 2005 Percent of population with risk Source: Michigan Behavior Risk Factor Surveillance System

Cancer: 

Cancer A diverse group of diseases characterized by uncontrolled growth and spread of abnormal cells

Breast Cancer Incidence and Mortality by Race: 

Breast Cancer Incidence and Mortality by Race *Adjusted to 2000 US standard population. Age-adjusted rate per 100,000* Source: Vital Records & Health Data Development Section, Michigan Department of Community Health

Cervical Cancer Incidence and Mortality by Race: 

Cervical Cancer Incidence and Mortality by Race *Adjusted to 2000 US standard population. Age-adjusted rate per 100,000* Source: Vital Records & Health Data Development Section, Michigan Department of Community Health

Colorectal Cancer Incidence and Mortality by Race: 

Colorectal Cancer Incidence and Mortality by Race *Adjusted to 2000 US standard population. Age-adjusted rate per 100,000* Source: Vital Records & Health Data Development Section, Michigan Department of Community Health

Lung Cancer Incidence and Mortality by Race: 

Lung Cancer Incidence and Mortality by Race *Adjusted to 2000 US standard population. Age-adjusted rate per 100,000* Source: Vital Records & Health Data Development Section, Michigan Department of Community Health

Prostate Cancer Incidence and Mortality by Race: 

Prostate Cancer Incidence and Mortality by Race *Adjusted to 2000 US standard population. Age-adjusted rate per 100,000* Source: Vital Records & Health Data Development Section, Michigan Department of Community Health

Cardiovascular Disease: 

Cardiovascular Disease Any disease that affects the heart or blood vessels by restricting the flow of blood.

Slide22: 

Source: Vital Records & Health Data Development Section, Michigan Department of Community Health

Slide23: 

Source: Vital Records & Health Data Development Section, Michigan Department of Community Health

Diabetes: 

Diabetes A chronic disease characterized by the inability to use the glucose in food for energy.

Prevalence of Diabetes by Race/Ethnicity, Michigan & U.S. : 

Prevalence of Diabetes by Race/Ethnicity, Michigan & U.S. Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005. 002 data; CDC. (2004) National Diabetes Fact Sheet ; Diabetes Care, July, 2003

Deaths Due to Diabetes per 100K: 

Deaths Due to Diabetes per 100K Source: Vital Records & Health Data Development Section, Michigan Department of Community Health

HIV/AIDS: 

HIV/AIDS HIV: Human Immunodeficiency Virus Transmission: Unprotected Anal/Vaginal/Oral Sex Needle Sharing Maternal AIDS: Acquired Immune Deficiency Syndrome

Prevalence Estimates of Persons Living with HIV/AIDS in MI by Sex and Race as of October 1, 2006: 

Prevalence Estimates of Persons Living with HIV/AIDS in MI by Sex and Race as of October 1, 2006 Prevalence Estimate MDCH/Bureau of Epidemiology/HIV/AIDS Surveillance Program

HIV Related Deaths in MI, all ages, by Race & Sex, 1990-2005*: 

HIV Related Deaths in MI, all ages, by Race & Sex, 1990-2005* *Deaths for 2005 may be incomplete. MDCH/Bureau of Epidemiology/HIV/AIDS Surveillance Program

Infant Mortality : 

Infant Mortality The number of deaths occurring in children under the age of one year.

Race specific Infant Mortality Rate Michigan compared to US: 

Race specific Infant Mortality Rate Michigan compared to US Source: Vital Records & Health Data Development Section, Michigan Department of Community Health

Eliminating Disparities: 

Eliminating Disparities “We cannot become what we need to be by remaining what we are” Max Depree

General Recommendations: 

General Recommendations New knowledge about the determinants of disease Develop infrastructure capacity of community-based organizations Programs must emphasize behavioral risk-reduction and other prevention strategies Communities must assist at-risk individuals in accessing programs designed to diagnose and treat conditions early Greater role of local leaders including faith-based and fraternal organizations Community level interventions to promote normative change Evidence-based strategies

General Recommendations (Cont.): 

General Recommendations (Cont.) Public Health safety net Integration of healthcare services, one stop shopping Development of comprehensive community health centers Comprehensive health screening programs for communities of color Culturally and gender appropriate skills-building workshops Mobile Outreach

Specific Groups Recommendations: 

Specific Groups Recommendations Schools (K-12): Add prevention messages to MI Model for Comprehensive School Health Education Curriculum. Urge the adoption of policies on healthy foods and beverages. Higher Education: Increase number of ethnically diverse/culturally competent providers (Michigan Diabetes Strategic Plan recommendations, 2003) Business: Create work-based risk-reduction, screening, self-management education among employer/union groups Healthcare: Support programs that serve minority populations; Promote culturally acceptable prevention disease management

Specific Groups Recommendations (Cont.): 

Specific Groups Recommendations (Cont.) Healthcare Organizations: Partner with professional organizations to improve awareness, knowledge and skills among health care providers Community Organizations: Promote messages and use of lay health workers among faith-based and other community organizations State Government: Target funding to reduce health disparities (Michigan Diabetes Strategic Plan recommendations, 2003) Media’s Role: Implement statewide public awareness campaign of health disparities

Slide37: 

Of all the forms of inequality, injustice in health care is the most shocking and inhumane. Martin Luther King Jr.

Health Disparities Work Group: 

Health Disparities Work Group Audrea M. Woodruff, Chairperson Acting Manager, HDRMH Fawzie Ahmed Sheila Embry Rhonda Bantsimba Sophia Hines Brandon Boyle Jacquetta Hinton Patricia Brookover Erma Leaphart-Gouch Alethia Carr Henry Miller Jean C. Chabut Amy Slonim Robert Cochran Debra Szwejda Arthur Davis Jada Williams Daniel Diepenhorst Paulette Dobynes Dunbar Konrad Edwards Dr. Kimberlydawn Wisdom, Surgeon General Dr. Kimberlydawn Wisdom, Surgeon General