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How does your grantmaking currently address health disparities?

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Presentation on theme: "How does your grantmaking currently address health disparities?"— Presentation transcript:

1 How does your grantmaking currently address health disparities?

2 Health Disparities and Achieving Health Equity in North Carolina Giselle Corbie-Smith, MD, MSc University of North Carolina at Chapel Hill NC Translational and Clinical Sciences Institute Program on Health Disparities Sheps Center for Health Services Research

3 Overview Definitions and frameworks Define social determinates of health (SDH) Interventions to achieve health equity Resources for learning more

4 Health Disparities “Health disparities are differences in health outcomes between groups that reflect social inequalities.” Often interchanged with health inequities Disparities can exist by: – race/ethnicity – gender – education – income – geographic location – sexual orientation – disability status er/su6001.pdf

5 Factors that Lead to Health Disparities Social Inequalities Social Inequalities Educational opportunities Educational opportunities Job opportunities Job opportunities Housing opportunities Housing opportunities Law enforcement patterns Law enforcement patterns Economic Inequalities Economic Inequalities Environmental Injustices Environmental Injustices Unequal Access to Health Care Services Unequal Access to Health Care Services Unequal Provision of Health Care Services Unequal Provision of Health Care Services

6 Heuristic Model of Racial Disparities in Health Outcomes (adapted from Williams 1997)

7 Social Determinates of Health “Social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities…” social_determinants/en/

8 A Key Social Determinant of Health Socioeconomic Status (SES) is a measure of income, education, employment opportunities, and social influence It is one of the most powerful predictors of health… more than genetics, carcinogen exposure or smoking. Mortality gap between high and low SES is GREATER than the gap between smokers and non-smokers in America /Dr-David-Williams-on-Health- Disparities

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10 United States: Gaps in Children’s General Health Status

11 United States: Gaps in Adult Health Status

12 Heart Disease and Stroke Disparities (Gender & Race) Heart Disease RateStroke Rate Female103.1 ( )42.6 ( ) Male176.5 ( )43.9 ( ) American Indian/ Alaskan Native 97.4 ( )29.4 ( ) Asian/Pacific Islander77.1 ( )37.0 ( ) Black161.6 ( )61.6 ( ) Hispanic106.4 ( )34.2 ( ) White134.2 ( )41.7 ( ) Number of deaths and age-adjusted death rates* for coronary heart disease and stroke, by sex and race/ethnicity — National Vital Statistics System, United States, er/su6001.pdf

13 Infant Mortality Disparities (Race) Maternal Race/EthnicityInfant Mortality Rate (2000) Infant Mortality Rate (2006) American Indian/ Alaskan Native Asian/Pacific Islander Black, Non-Hispanic White, Non-Hispanic Hispanic Total er/su6001.pdf

14 The Latino Paradox Since the early 1980’s Latino birth outcomes have been equal or better than the birth outcomes of white women Despite population having less income, insurance and education Benefit attributed to healthier food and lifestyles while pregnant Effect diminishes with acculturation Ceballos

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19 What is a Disparity in Healthcare? Populations with Equal Access to Health Care SOURCE: Gomes and McGuire, 2001, National Academy of Sciences

20 Potential Origins for Disparities in Healthcare Kilbourne

21 Van Ryn, Michelle, “Research on the Provider Contribution to Race/Ethnicity Disparities in Medical Care.” Medical Care 40(1) I

22 Unequal Access to Health Care Services Availability: physical presence of health services for potential users: – proximity – operating hours & service scope Accessibility: the means that people have to obtain medical services – Financing – Transportation – Waiting time (to appt; in office) – Language barriers

23 Unequal Access to Health Care Services Acceptability: the extent to which services meet users’ value orientations – Patient satisfaction – “Cultural competence” Providers Organization

24 Percent of Population aged Years with No Health Insurance by Income: US, HispanicNon-Hispanic WhiteNon-Hispanic Black CDC

25 Health Disparities Data: North Carolina

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29 NC State Center for Health Statistics

30 NC: % of Adults who could NOT see a doctor in previous 12 months due to cost

31 NC CATCH

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33 BRFSS, 2007

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35 Individual Cultural Socioeconomic Biological & Clinical Behavioral Living Conditions Social/Environmental Racial Segregation Social Cohesion/Social Capital Income Disparity Exposures (Social, Environmental,…) System/Policy Organization & staffing Insurance Supply & Distribution of Clinicians & other Resources Provider Knowledge Attitudes Practice Patterns Communication Cultural Competence Health Care Disparities: Access to Care Structure of Care Process of Care Patient Satisfaction Health Status Disparities Morbidity & Mortality Health Status [Self-report/ measured] Functional Status CHERP Health Disparities Primer Health Outcomes Classical Epidemiology Continuity & Concordance Varying Patient preferences Health behavior Varying effectiveness or style Varying resources constraints Political Economy Health Care

36 Individual Cultural Socioeconomic Biological & Clinical Behavioral Living Conditions Social/Environmental Racial Segregation Social Cohesion/Social Capital Income Disparity Exposures (Social, Environmental,…) System/Policy Organization & staffing Insurance Supply & Distribution of Clinicians & other Resources Provider Knowledge Attitudes Practice Patterns Communication Cultural Competence Health Care Disparities: Access to Care Structure of Care Process of Care Patient Satisfaction Health Status Disparities Morbidity & Mortality Health Status [Self-report/ measured] Functional Status CHERP Health Disparities Primer Health Outcomes Classical Epidemiology Continuity & Concordance Varying Patient preferences Health behavior Varying effectiveness or style Varying resources constraints Political Economy Health Care

37 Individual Cultural Socioeconomic Biological & Clinical Behavioral Living Conditions Social/Environmental Racial Segregation Social Cohesion/Social Capital Income Disparity Exposures (Social, Environmental,…) System/Policy Organization & staffing Insurance Supply & Distribution of Clinicians & other Resources Provider Knowledge Attitudes Practice Patterns Communication Cultural Competence Health Care Disparities: Access to Care Structure of Care Process of Care Patient Satisfaction Health Status Disparities Morbidity & Mortality Health Status [Self-report/ measured] Functional Status CHERP Health Disparities Primer Health Outcomes Classical Epidemiology Continuity & Concordance Varying Patient preferences Health behavior Varying effectiveness or style Varying resources constraints Political Economy Health Care

38 Individual Cultural Socioeconomic Biological & Clinical Behavioral Living Conditions Social/Environmental Racial Segregation Social Cohesion/Social Capital Income Disparity Exposures (Social, Environmental,…) System/Policy Organization & staffing Insurance Supply & Distribution of Clinicians & other Resources Provider Knowledge Attitudes Practice Patterns Communication Cultural Competence Health Care Disparities: Access to Care Structure of Care Process of Care Patient Satisfaction Health Status Disparities Morbidity & Mortality Health Status [Self-report/ measured] Functional Status CHERP Health Disparities Primer Health Outcomes Classical Epidemiology Continuity & Concordance Varying Patient preferences Health behavior Varying effectiveness or style Varying resources constraints Political Economy Health Care

39 Individual Cultural Socioeconomic Biological & Clinical Behavioral Living Conditions Social/Environmental Racial Segregation Social Cohesion/Social Capital Income Disparity Exposures (Social, Environmental,…) System/Policy Organization & staffing Insurance Supply & Distribution of Clinicians & other Resources Provider Knowledge Attitudes Practice Patterns Communication Cultural Competence Health Care Disparities: Access to Care Structure of Care Process of Care Patient Satisfaction Health Status Disparities Morbidity & Mortality Health Status [Self-report/ measured] Functional Status CHERP Health Disparities Primer Health Outcomes Classical Epidemiology Continuity & Concordance Varying Patient preferences Health behavior Varying effectiveness or style Varying resources constraints Political Economy Health Care

40 Individual Cultural Socioeconomic Biological & Clinical Behavioral Living Conditions Social/Environmental Racial Segregation Social Cohesion/Social Capital Income Disparity Exposures (Social, Environmental,…) System/Policy Organization & staffing Insurance Supply & Distribution of Clinicians & other Resources Provider Knowledge Attitudes Practice Patterns Communication Cultural Competence Health Care Disparities: Access to Care Structure of Care Process of Care Patient Satisfaction Health Status Disparities Morbidity & Mortality Health Status [Self-report/ measured] Functional Status CHERP Health Disparities Primer Health Outcomes Classical Epidemiology Continuity & Concordance Varying Patient preferences Health behavior Varying effectiveness or style Varying resources constraints Political Economy Health Care

41 Individual Cultural Socioeconomic Biological & Clinical Behavioral Living Conditions Social/Environmental Racial Segregation Social Cohesion/Social Capital Income Disparity Exposures (Social, Environmental,…) System/Policy Organization & staffing Insurance Supply & Distribution of Clinicians & other Resources Provider Knowledge Attitudes Practice Patterns Communication Cultural Competence Health Care Disparities: Access to Care Structure of Care Process of Care Patient Satisfaction Health Status Disparities Morbidity & Mortality Health Status [Self-report/ measured] Functional Status CHERP Health Disparities Primer Health Outcomes Classical Epidemiology Continuity & Concordance Varying Patient preferences Health behavior Varying effectiveness or style Varying resources constraints Political Economy Health Care

42 More Information… “CDC Health Disparities and Inequalities Report — United States, 2011” Report outlining over 20 types of disparities categorized by: Social Determinates of Health Health-Care Access Mortality Morbidity Behavioral Risk Factors

43 Interventions to address Health Disparities

44 Science of Eliminating Health Disparities: NIH Recommendations Partnerships and collaborations are critical Need to build health disparity research capacity and expand training opportunities for new researchers Electronic and print media need to be partners for disseminating information about health disparities and related research findings

45 Eliminating Health Disparities Complex social problems require multifaceted responses Require detecting, understanding and reducing the disparity Kilbourne

46 Example of Research Address SD HOPE Works Interested in addressing obesity BUT, women struggling with finances could not buy healthier foods Created a business that makes conference bags AND disseminated health information in sew circles that make conference bags

47 EBIs Addressing Health Disparities Name of InterventionTargeted OutcomeDisparities Addressed Body and SoulIncrease fruit and vegetable consumption among African American faith groups Strives to address nutrition related disparities affecting African Americans Eat for LifeIncrease fruit and vegetable consumption among African Americans Strives to address nutrition related disparities affecting African Americans Little by LittleIncrease fruit and vegetable consumption among low income women Strives to address nutrition related disparities affecting low income women

48 What can Philanthropic organizations do? Collaborative efforts between those traditionally involved with health and those with a focus on children, housing, the environment or nutrition Work across sectors—and with their public agency counterparts—to develop an integrated agenda that capitalizes on new investments in community programs to produce health benefits

49 What can Philanthropic organizations do? Support initiatives in disadvantaged communities that create opportunities for healthy living and healthy choices Identify, support and champion innovative models of community building and design Build on existing evidence in program design Join with federal and state agencies and businesses as partners in supporting and rigorously evaluating place-based, multisector demonstrations

50 Questions?

51 References & Websites Monographs RWJ Commission for a Healthier America Journal Articles Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, Ceballos M, Palloni A. Maternal and infant health of Mexican immigrants in the USA: the effects of acculturation, duration, and selective return migration. Ethn Health. Aug 2010;15(4): Kilbourne AM, Switzer G, Hyman K, Crowley-Matoka M, Fine MJ. Advancing health disparities research within the health care system: a conceptual framework. Am J Public Health. Dec 2006;96(12): Websites

52 What are the direct and indirect ways of how funders can impact health disparities? How can you address health disparities in your grantmaking in the future?

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54 Health Disparities & Health Reform IssueHealth Reform Law Health Insurance Exchanges Raise awareness on health benefit plans in a culturally and linguistically appropriate manner, and prohibits the denial of benefits due to discrimination Individual and Group Market Insurance Explanations of coverage benefits must be written in culturally and linguistically appropriate language

55 Health Disparities & Reform Cont… IssueHealth Reform Law WorkforceGrants, loan repayment programs and funding for health workers including primary care providers, dentists, public health professionals, community health workers, etc.. Some specifically for minorities Funding for Centers of Excellence, and for diversity training for health professionals Funding for interdisciplinary, community-based work Healthcare workforce assessment of health professional shortage for medically underserved Special funds for rural physician training programs and investments for Historically Black Colleges and other Minority Institutions Additional Funding and Grants Grants from the Office of Minority Health to reduce disparities Expanded research endowments from the National Center on Minority Health and Health Disparities Funds and compliance requirements for Community Health Centers Funds to reduce readmissions to hospitals Departments for Under- represented Establish an Office of Women’s Health Extend benefits for Indian health Care Improvement Bill

56 Health Disparities & Reform Cont… IssueHealth Reform Law PreventionGrants for family planning for high-risk, vulnerable an culturally under- represented youth populations Grants for School-Based Health Centers in medically underserved areas Grants for preventing chronic diseases through public health interventions, community transformation grants, childhood obesity demonstration project and programs devoted to breast caner and diabetes prevention Oral Healthcare campaign targeted at minorities Programs to make healthcare systems and services more accessible to individuals with disabilities Quality Improvement & Comparative Effectiveness Create a national strategy for quality improvement including plans to reduce health disparities Reduce maternal and child health disparities Increase use of medical home model and collaborative care between providers and patients to deliver culturally appropriate care Research on comparative effectiveness for health conditions Data Collection & Reporting Data collection/analysis program to understand causes of health disparities Requirement for non-profit hospitals to create a 3 year community health assessment

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58 Poverty and Lack of Access to Health Care by Racial Group: North Carolina, 2001 NC-OMHHD/SCHS, 2003

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62 Six Access Measures

63 Changes in Access Measures

64 22 Quality Measures

65 Changes in 20 quality measures

66 Percent Distribution of Body Weight for Adults aged 18+: US, CDC, Vital and Health Statistics, 2002

67 Life Expectancy at Birth - USA NCHS, 2000 Life Expectancy (yrs) White Male Black Male White Female Black Female

68 Breast Cancer Incidence Breast Cancer Mortality White Women Black Women White Women Black Women National Center for Health Statistics, USA (1998)

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71 Postoperative sepsis per 1,000 elective-surgery discharges* by Median Income Patient Zipcode, US, 2003 *stays longer than 3 day (excluding patients admitted for infection)

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74 Moses Cone Foundation Cone Health Foundation is putting its resources into four areas: access to healthcare, HIV/AIDS and other sexually transmitted infections, adolescent pregnancy prevention and substance abuse/mental health. Local funder focused on local needs first, but are beginning to have a regional and statewide catchment area if that research can ultimately benefit the Greensboro community. _foundation.cfm?id=3242


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