Gaynor Health Disparities Talk

AGING AND HEALTHIN AMERICATrends and Dimensions: 

AGING AND HEALTH IN AMERICA Trends and Dimensions Bill Gaynor Center for Healthy Aging and Oregon Geriatric Education Center at Oregon Health andamp; Science University

TREND ONE: 

TREND ONE Increasing Diversity

Increasing Population Diversity(U.S. Census Bureau, 2002): 

Increasing Population Diversity (U.S. Census Bureau, 2002)

Slide4: 

TREND TWO: 

TREND TWO Population Aging

“They aren’t making mirrors like they used to.” Tallulah Bankhead: 

'They aren’t making mirrors like they used to.' Tallulah Bankhead

Slide7: 

Population Aging (U.S. Census Bureau, 2002): 

Population Aging (U.S. Census Bureau, 2002)

Population Aging: 

Population Aging What’s driving it?

Population Aging: 

Population Aging What’s driving it? 'Baby Boom'

Population Aging: 

Population Aging What’s driving it? 'Baby Boom' Decreasing Mortality (higher life expectancy)

Population AgingWeeks, 2002: 

Population Aging Weeks, 2002 What’s driving it? 'Baby Boom' Decreasing Mortality (higher life expectancy) Lower Fertility Rates

Population Aging (U.S. Census Bureau, 2002): 

Population Aging (U.S. Census Bureau, 2002)

Population Aging (U.S. Census Bureau, 2002): 

Population Aging (U.S. Census Bureau, 2002)

Population Aging (U.S. Census Bureau, 2002): 

Population Aging (U.S. Census Bureau, 2002)

Population Aging (U.S. Census Bureau, 2002): 

Population Aging (U.S. Census Bureau, 2002)

Population Aging (U.S. Census Bureau, 2002) Hispanic (all races): 

Population Aging (U.S. Census Bureau, 2002) Hispanic (all races)

TREND THREE: 

TREND THREE From '20th Century' Diseases To '21st Century' Diseases

20th Century DiseasesNational Office of Vital Statistics, 1947: 

20th Century Diseases National Office of Vital Statistics, 1947 Leading Causes of Death, 1900: + pneumonia andamp; influenza + tuberculosis + diarrhea, enteritis

20th Century Diseases: 

20th Century Diseases Leading Causes of Death, 1900: + pneumonia andamp; influenza + tuberculosis + diarrhea, enteritis What are the 'causes' of these causes of death?

21st Century DiseasesCDC, 2005: 

21st Century Diseases CDC, 2005 Leading Causes of Death, 2001: +heart disease +malignant neoplasms +cerebrovascular

21st Century Diseases: 

21st Century Diseases Leading Causes of Death, 2001: +heart disease +malignant neoplasms +cerebrovascular What are the 'causes' of these causes of death?

21st Century Diseases: 

21st Century Diseases

21st Century Diseases: 

21st Century Diseases

TREND FOUR: 

TREND FOUR Weight

Obesity Trends* Among U.S. AdultsBRFSS, 1985: 

Obesity Trends* Among U.S. Adults BRFSS, 1985 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1988: 

Obesity Trends* Among U.S. Adults BRFSS, 1988 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1990: 

Obesity Trends* Among U.S. Adults BRFSS, 1990 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1992: 

Obesity Trends* Among U.S. Adults BRFSS, 1992 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1993: 

Obesity Trends* Among U.S. Adults BRFSS, 1993 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1994: 

Obesity Trends* Among U.S. Adults BRFSS, 1994 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1995: 

Obesity Trends* Among U.S. Adults BRFSS, 1995 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1996: 

Obesity Trends* Among U.S. Adults BRFSS, 1996 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1997: 

Obesity Trends* Among U.S. Adults BRFSS, 1997 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1998: 

Obesity Trends* Among U.S. Adults BRFSS, 1998 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 1999: 

Obesity Trends* Among U.S. Adults BRFSS, 1999 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 2000: 

Obesity Trends* Among U.S. Adults BRFSS, 2000 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Obesity Trends* Among U.S. AdultsBRFSS, 2001: 

Obesity Trends* Among U.S. Adults BRFSS, 2001 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Slide39: 

Obesity Trends* Among U.S. AdultsBRFSS, 1996: 

Obesity Trends* Among U.S. Adults BRFSS, 1996 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

Slide41: 

Slide42: 

Dimension One: 

Dimension One Socioeconomic Differences in Aging

Slide44: 

Slide45: 

Slide46: 

Income and Health von dem Knesebeck, et al., 2003: 

Income and Health von dem Knesebeck, et al., 2003

Slide48: 

Slide49: 

Dimension Two: 

Dimension Two Health Disparities By Age

Slide51: 

Slide52: 

Slide53: 

Suicide: 

Suicide 'Elder Suicide Has State Worried' Oregonian Headline 8/23/05 65 + has the highest suicide rate of any age group (~17/100K) (general population rate ~ 11/100K) Higher in Oregon (~ 25/100K) Higher among men (~4:1 ratio) Firearms most common method (@ 80%, poisoning a distant 2nd @ 10%)

Incidence of Selected Conditions: 

Incidence of Selected Conditions

Dimension Three: 

Dimension Three Health Disparities in the Elderly By Race and Ethnicity

Slide57: 

Slide58: 

Differential Mortality RatesSatcher, et al., 2005: 

Differential Mortality Rates Satcher, et al., 2005

Differences in Medicare Procedure RatesBlack Males <> White MalesJha, et al., 2005: 

Differences in Medicare Procedure Rates Black Males andlt;andgt; White Males Jha, et al., 2005

Differences in Medicare Procedure RatesBlack Females <> White Females Jha, et al., 2005: 

Differences in Medicare Procedure Rates Black Females andlt;andgt; White Females Jha, et al., 2005

Trends and Dimensions: 

Trends and Dimensions Diversity Socioeconomic Differences in Aging Population Aging Health Disparities in Aging Overweight / Obesity Disparities in Aging by Race/Ethnicity 20th - 21st Century Diseases

What will be some of the consequences as these trends and dimensions converge?: 

What will be some of the consequences as these trends and dimensions converge? + public health consequences? +implications for the economy? +impact on health systems? +implications for families? +impact on health workforce? +implications for housing? +implications for transportation?

Five ideas…..: 

Five ideas…..

1. Yes, disparities have complex historical and social roots, but....the health professions should lead, not lag, in the effort to eliminate disparities.: 

1. Yes, disparities have complex historical and social roots, but.... the health professions should lead, not lag, in the effort to eliminate disparities. Yes, devote more of the curriculum to cultural competence, but also… Cultural immersion experience a prerequisite for admission(andgt; 6 months) One year practicing in underserved population a requirement for full licensure.

2. Pay for results.(“fee-for-solutions”): 

2. Pay for results. ('fee-for-solutions') Medicare was able to force desegregation of hospitals in the late 1960’s Medicare now proposing to pay for outcomes …make elimination of disparities an outcome!

3. New emphasis on health promotion, especially physical activity: 

3. New emphasis on health promotion, especially physical activity Restore support for school 'P.E' programs Promote urban design for healthy communities Require health insurers to cover health promotion (health coaching? personal trainers? gym memberships?)

4. Continue efforts / experiments in disease management & health behaviors (“self as healer”): 

4. Continue efforts / experiments in disease management andamp; health behaviors ('self as healer') Train all health professions students in motivational interviewing Health insurers provide infrastructure and venue for Chronic Disease Self Management Programs (Lorig, et al., 2001) Continue to develop 'group office visit' Approach

5. Make Poverty History: 

5. Make Poverty History

References(For those sources where full reference is not given directly on the slide.): 

References (For those sources where full reference is not given directly on the slide.) CDC - Centers for Disease Control and Prevention, National Center for Injury Control and Prevention. 2005. http://webapp.cdc.gov/sasweb/ncipc/leadcaus10.html Jha, Ashish K.,Elliott S. Fisher, Zhonge Li, E. John Orav and Arnold M. Epstein. 2005. Racial trends in the use of major procedures among the elderly. New England Journal of Medicine 353(7):683-691. Lorig, K. R., Ritter, P., Stewart, A.L., Sobel, D.S., Brown, B.W., Bandura, A., et al. (2001) Chronic disease self management program. Medical Care, 39:1217-1223 National Office of Vital Statistics, 1947. http://www.cdc.gov/nchs/data/dvs/lead1900_98.pdf Satcher, David, George E. Fryer, Jr., Jessica McCann, Adewale Troutman, Steven H. Woolf and George Rust. 2005. What if we were equal? A comparison of the black-white mortality gap in 1960 and 2000. Health Affairs 24(2):459-464. U.S. Census Bureau, Population Division, Population Projections Branch. 2002. http://www.census.gov/population/www/projections/natsum-T3.html Von dem Knesebeck, Olaf, Gunther Luschen, William Cockerham, Johannes Siegrist. 2003. Socioeconomic status and health among the aged in the United States ant Germany: A comparative cross-sectional study. Social Science and Medicine 57:1643-1652. Weeks, John R. 2002. Population: An Introduction to Concepts and Issues. Wadsworth/Thompson Learning: Belmont, CA.