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Racial and Ethnic Health care Disparities Vivien S. Fongue, OMS III Des Peres Hospital October 2006.

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Presentation on theme: "Racial and Ethnic Health care Disparities Vivien S. Fongue, OMS III Des Peres Hospital October 2006."— Presentation transcript:

1 Racial and Ethnic Health care Disparities Vivien S. Fongue, OMS III Des Peres Hospital October 2006

2 Racial and Ethnic Disparities African Americans have the highest mortality rates from heart disease, cancer, cerebrovascular disease and HIV/AIDs American Indians disproportionately die from diabetes, liver disease/cirrhosis and unintentional injuries Hispanic Americans are twice as likely to die from diabetes

3 Access? Compared ethnic/racial minorities to whites Less likely to have health insurance Fewer choices where to receive health care More likely to receive care in an Emergency Room Less likely to have a regular primary care provider

4 Resources? Compared ethnic/racial minorities to whites Disproportionately represented in lower socioeconomic groups Complete less education Live in poorer neighborhoods with Violence Pollution Inferior infrastructure

5 Just Fix Access and Resources Evidence Growing that at Equivalent Levels of Access Racial and Ethnic Minorities are LESS likely than Whites to Receive Quality Health Care Receive EVEN routine Medical Procedures Congress asked the Institute of Medicine to study this issue in 1999.

6 Institute of Medicine Report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2002) Assess extent of disparity unrelated to access Evaluate potential sources Bias, discrimination and stereotyping Individual, institutional and health system Provide recommendations to eliminate disparities

7 Definitions Quality of Care quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (IOM, Measuring Quality Health Care, 1990)

8 Definitions Race and Ethnicity 2001 OMB definitions American Native, Asian, African American, Pacific Islander, White, Hispanic, Not-Hispanic Race as a social construct Self definition

9 Why Should We Care? Public Trust in Health Professionals Social Triaging – Am I next? The Health of One is the Health of All Infectious Diseases Economic Considerations Later Diagnosis Leads to Complications Legacy of Racial Discrimination

10 IOM Literature Review Ethnic/Racial Disparities 600 citations Published 1992-2002 Peer-reviewed Journals Examined Variation in Medical Care Met Principles of Scientific Research Adequate Control for Access

11 Racial/Ethnic Disparities Cardiovascular Care Compared to White patients: Lesser rates of thrombolytics, beta blockers and aspirin. Lesser rates of catheterization Lesser rates of revascularization Lesser rates of PTCA Teaching hospitals like Private hospitals Worsened Mortality

12 Racial/Ethnic Disparities Cancer Breast Cancer – African American Women less likely to get progesterone receptors, less like to be offered reconstruction Prostate Cancer – African American Men less likely to get prostatectomy African Americans less likely to get post treatment surveillance Analgesia- African Americans less

13 Racial/Ethnic Disparities Cerebrovascular Diesease African Americans half as likely as Whites to get imaging studies after TIA Whites more likely to get endarterectomy African Americans less likely to receive anti-coagulant therapy African Americans less likely to see a Neurologist

14 Racial/Ethnic Disparities Renal Transplantation African Americans less likely to be offered peritoneal dialysis African Americans less likely to be placed on the transplant list African Americans less likely to receive transplant

15 Racial/Ethnic Disparities HIV/AIDs African Americans less likely to receive antiretroviral therapy African Americans less likely to receive prophylaxis for Pneumocystis carinii African Americans less likely to receive protease inhibitors

16 Racial/Ethnic Disparities African Americans greater morbidity/mortality from ASTHMA African Americans, Hispanics and Native Americans experience 50-100% higher morbidity/mortality from DIABETES Mental Health Services less

17 Racial/Ethnic Disparities Analgesia Hispanic patients treated in ER for long bone fractures twice as likely as whites to be dismissed with NO ANALGESIA Another study of African American patients 63% more likely to be dismissed with NO ANALGESIA Minority Cancer patients more likely to receive INADEQUATE pain management

18 Responsibility Individual We may be unaware of our own biases and prejudices Education Institutional Speak up in our own institutions System Speak up politically

19 Rural Healthcare Disparities 1999-2000 National Health Interview Surveys Included 34.6 million Adults were surveyed 84.4% white, 8.0% black, 4.9% Hispanic and 2.7% other racial backgrounds

20 Rural Health Care Disparities 5 million of these rural adults self reported decreased ability to carry out daily activities. Rural residents were educationally and financially worse off than their urban counterparts, minorities more so than whites.

21 Rural Health Care Disparities Urban whites had a 73.2% chance of having employer sponsored health insurance. Rural whites had a 63.7% chance, Rural blacks a 46.8% chance, Rural Hispanics a 52.4% and Rural other a 51.9%. Minorities were more likely to have government health insurance coverage.

22 Rural Health Care Disparities Rural minorities were less likely to have a regular source of care and reported fewer health care visits. Rural residents were less likely than urban residents to have seen a dentist in the past year Rural residents were more likely to have visited an emergency room.

23 Rural Health Care Disparities Infant mortality rates are 26% higher in rural than suburban America. The death rate for persons aged one to twenty four is 31% higher than even urban rates. The death rate for persons 25-64 years was 32% higher than suburban rates The death rate for those over 65 was 7% higher.

24 Rural Health Care Disparities Rural residents smoke more Rural residents exercise less Rural residents are more likely to be obese than the general population Health is defined by physical vitality and productivity. Short term solutions to stay at work can mean long term complications

25 Rural Health Care Disparities Rural patients with MYOCARDIAL INFARCTION had higher mortality rates even when the admissions were controlled for comorbidities. Several of the missed opportunities for intervention consisted of oral or intravenous medications and did not require high technology services. Patients transferred who were more likely to be white, male and younger were more likely to get recommended treatments.

26 Rural Health Care Disparities CERVICAL CANCER deaths are higher in rural areas The use of regular Pap smears for early detection of cervical cancer is lower. It is also discouraging to note a report indicating that physicians practicing in rural areas are less likely to recommend Pap smears.

27 Rural Health Care Disparities Rural women with BREAST CANCER were not as likely to have an adequate determination of estrogen receptor status These women were also less likely to receive radiation therapy as part of treatment. Finally, breast conservation surgery in place of more extensive mastectomy was not offered as often

28 Rural Health Care Disparities Data suggest that physicians treating HIV/AIDs in rural settings have fewer total patients with the disease and thus less experience Rural patients were less likely to receive courses of highly active antiretroviral therapy (HAART). Rural patients were also less likely to receive preventive antibiotics for Pneumocystis carinii pneumonia,.

29 Improving Rural Health Care As part of the series Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine released Quality Through Collaboration: The Future of Rural Health in November of 2004.[1] This Committee made five recommendations to improve healthcare for rural Americans.Quality Through Collaboration: The Future of Rural Health in November of 2004.[1]

30 Improving Rural Health Care IOM recommendations 1. Improve payment for services. 2. Recruit more healthcare personnel to work in Rural areas. 3. Shift emphasis to population health. 4. Create Quality Improvement networks 5. Increase information and digital communication.

31 Global Health Care Disparities Article 25, Universal Declaration of Human Rights: Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the vent of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond control

32 Global Health Care Disparities Life expectancies: Developed countries – 78 years East Asia – 69 years Sub-saharan Africa – 47 years

33 Global Health Care Disparities Malaria kills 3,000,000 people a year. Most of the victims are CHILDREN. 90% are in Africa. Malaria is treatable. The treatment is cheap. Prevention is elementary.

34 Simple Steps Primary education for all children. Nutrition programs. Antimalarial bed nets. Safe drinking water. The UN Millenium Project

35 What would it cost? Fair contribution from developed countries. For the United States 70 cents of every 100 dollars of our GNP. United States current contribution 15 cents of every 100 dollars of our GNP.

36 Responsibility Individual We may be unaware of our own biases and prejudices Education Institutional Speak up in our own institutions System Speak up politically

37 Health Care Disparities Let no one be discouraged by the belief there is nothing one man or one woman can do against the enormous array of the worlds ills – against misery and ignorance, injustice and violence…few will have the greatness to bend history itself; but each of us can work to change a small portion of events, and in the total of all those acts will be written the history of this generation…..

38 Health Care Disparities It is in the numberless diverse acts of courage and belief that human history is shaped. Each time a man stands up for an ideal, or acts to improve the lot of others, or strikes out against injustice,

39 Health Care Disparities He sends a tiny ripple of hope, and crossing each other from a million different centers of energy and daring, those ripples build a current which can sweep down the mightiest walls of oppression and resistance. Robert F. Kennedy

40 References IOM Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2002) IOM, Measuring Quality Health Care, (1990) OMB Definitions of Race, 2001 1999-2000 National Health Interview Surveys Included IOM Quality Through Collaboration: The Future of Rural Health in November of (2004) Article 25, Universal Declaration of Human Rights The End of Poverty, Jeffrey Sachs,


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