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Citizens’ Health Care Working Group Adela S. Valdez M.D. Past Presiding Officer Health Disparities Task Force Asst. Dean for Education, UTHSCSA-RAHC.

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Presentation on theme: "Citizens’ Health Care Working Group Adela S. Valdez M.D. Past Presiding Officer Health Disparities Task Force Asst. Dean for Education, UTHSCSA-RAHC."— Presentation transcript:

1 Citizens’ Health Care Working Group Adela S. Valdez M.D. Past Presiding Officer Health Disparities Task Force Asst. Dean for Education, UTHSCSA-RAHC

2 Citizens’ Health Care Working Group Objectives Review how HDTF and DSHS approached Health Disparities with overview of Hispanic Health Disparities Review organizational processes utilized to address Health Disparities Highlight best practices Lessons learned

3 Review HDTF and DSHS approach to Health Disparities

4 Priority Health Areas - USDHHS  Infant mortality  Cancer  Cardiovascular disease  Diabetes  HIV/AIDS  Immunizations

5 OMH AND HDTF Initiatives OMH AND HDTF Initiatives Immunizations Obesity and Diabetes Prevention( CA, CV disease) Physical Activity and Fitness (CV disease) Tobacco Use (Cancer prevention) Responsible Sexual Behavior (HIV/AIDS) Prenatal Care (Infant mortality)

6 Burden of Chronic Diseases and Racial/Ethnic Disparities

7 Causes of Death in United States-2000


9 Obesity

10 Obesity Trends* Among U.S. Adults BRFSS, 2002

11 America’s Fattest Cities - 2004

12 The Perfect Storm

13 Lifestyle Changes that Promote Sedentary Behavior

14 Tobacco Prevention and Control Tobacco remains the single most preventable cause of death and disease in Texas and the US Over 24,000 Texans Die each year Cost of over $10 Billion dollars In 1998, about 15% of all Texas Medicaid expenditures

15 Success of Tobacco Intervention

16 Trends in Cigarette Smoking Prevalence

17 Plan to resolve the problem Appropriate Funds allocated into six main components: –Community and School based –Public Awareness –Cessation efforts with Quitline –Efforts targeting specific populations –Youths in alternate settings –Enforcement of tobacco control policies Pilot initiatives in four East Texas Counties –Jefferson, Harris, Fort Bend, and Montgomery

18 Results After first two years of implementation 36% reduction in 6 th -12 th grade tobacco users in East Texas ~ 55,000 fewer 6 th – 12 th graders using tobacco products as result of the comprehensive program 18.6 % reduction in adult smoking rates which translates to 90,000 fewer adult smokers in the area

19 Overview of Hispanic Health Disparities

20 CHANGING POPULATION DEMOGRAPHICS EDUCATION Hispanics and Blacks, in general, are disproportionately undereducated. School drop-out rates are excessively high. SAT scores for Hispanic and Black students are relatively low. Enrollment in early childhood education programs (Head Start, kindergarten) disproportionately low.

21 HEALTH PROFESSIONALS GENERAL Hispanics and Blacks are disproportionately underrepresented in virtually ALL the health professions. The underrepresentation involves those in practice, academia, research fields, post- baccalaureate degrees.

22 HISPANICS IN DECISION-MAKING POSITIONS Major disparity in the number/proportion of Hispanics and Blacks in decision-making positions in the health professions, state/national bodies, business sector, educational sector, governmental sector, etc.

23 HEALTH INSURANCE Hispanics and Blacks in U.S. and Texas are disproportionately underinsured and uninsured. This problem is greater among Hispanics in the Southwest and even greater still in communities closer to the U.S.-Mexico border.

24 Texas Has the Highest Uninsured Rate in the Nation

25 Majority of Uninsureds Are Employed Employed Percent Texas Uninsured by Labor Status Not in Labor Force Unemployed 80% of Uninsured Hispanics Are Employed

26 HEALTH INSURANCE Texas ranks 2 nd among states in the percentage of children 0-17 years old who do not have public or private health insurance. 44 % of the uninsured children in Texas are Hispanic. Source: Office of Public Insurance Counsel

27 HEALTH INSURANCE For migrant children who are actually enrolled in the Texas Medicaid program, the coverage becomes moot as soon as they leave the state. Lack of health insurance affects access to health services, contributes to poorer health, higher hospitalization rates and more advanced disease state by time health services finally received.

28 Hispanics Typically Low Utilizers of Healthcare Services Lower Utilization of Healthcare Culture - Home remedies commonly first line of defense.Culture - Home remedies commonly first line of defense. Reactive vs Proactive HealthcareReactive vs Proactive Healthcare Women set the health agenda in the household.Women set the health agenda in the household. Fewer Hispanic Physicians Only 13% of the state’s 13,000 primary care physicians are Hispanic.Only 13% of the state’s 13,000 primary care physicians are Hispanic.

29 DIABETES (ADULT-ONSET TYPE) Higher rate of diabetes for Hispanics and Blacks Higher rate of diabetic complications Higher death rates for Hispanics and Blacks, 2 to 2.5 times higher than Anglos in 1990 and 2000 in Texas

30 DISEASE/HEALTH DISPARITIES HOMICIDES Homicide rate for Hispanic and Black males was 2 to 4 times higher than that for Anglo males in Texas in 1990 and 2000. (Rates among females are similar between Hispanics and Anglos.)

31 Age-Adjusted Death Rates for Cervical Cancer by Race/Ethnicity, Texas: 1995-1998 (Rate per 100,000 population) Source: Texas Department of Health, Vitalnet

32 SCREENING FOR BREAST CANCER Rates for breast examination by a clinician are lower in Hispanic and Black females.* 78.8% White, non-Hispanic 78.8% White, non-Hispanic 57.5% Hispanic 57.5% Hispanic 75.7% Black, non-Hispanic 75.7% Black, non-Hispanic *Data for 1998-2000

33 SCREENING FOR BREAST CANCER Rates for mammography are lowest for Hispanic females 61.0% Hispanic 61.0% Hispanic 72.1% Black, non-Hispanic 72.1% Black, non-Hispanic 71.5% White, non-Hispanic 71.5% White, non-Hispanic *Data for 1998-2000

34 DISEASE/HEALTH DISPARITIES TEENAGE PREGNANCY Hispanic and Black teenage pregnancy rate 2 to 3 times higher than that for White non-Hispanics. Percent unmarried (2/3 of teenage pregnancies) is similar between Hispanics and White non- Hispanics. Percent unmarried (about 94 percent of teenage pregnancies) much higher for Blacks. Rates over the last decade relatively stable.

35 DISEASE/HEALTH DISPARITIES OBESITY Being overweight and obesity are disproportionately increased in Hispanics and Blacks, particularly females.

36 DISEASE/HEALTH DISPARITIES MENTAL HEALTH Need more frequency information, risk factors, mental health care access, outcomes in Hispanics and Blacks in Texas and in the U.S.

37 SUMMARY Rapidly growing numbers Increased under-education, low income, language barriers Greater lack of access, underutilization, mis-utilization of health care system Greater uninsured, underinsured

38 REPRESENTATIVE HEALTH POLICY IMPLICATIONS Expansion of health insurance Increased inclusion of Latinos and Blacks in medical/health research as consumers, researchers Increased numbers of Latinos and Blacks in Academic Health institutions (administration, tenured faculty, researchers)

39 REPRESENTATIVE HEALTH POLICY IMPLICATIONS Enhancement of early educational opportunities. Dramatic focus needed in eliminating disparities in access to care, utilization of care, and preventive services.

40 CHALLENGES Increasing health care costs Lack of societal mandate for all to have sufficient access to the health system Increased expectations of health with increasing technology Improving health requires improving education, employment, decision-making capacity in a variety of community and organizational sector.

41 SUMMARY Major under representation in health professionals Major under presentation in decision-making bodies in health, government, business, education, entrepreneurs—arenas that intersect with health and health care Numerous health disparities (i.e., disproportionately greater disease burden) Less health and research data available


43 New Innovative Initiatives State Program Initiatives Regional Initiatives Texas State Heath Strategic Partnership

44 Strategies Eliminating health disparities in Texas requires an ability to identify and address the underlying causes of higher levels of disease…

45 Strategies Research is needed to understand why vulnerable populations have disparate health outcomes…

46 Strategies  Improved Access / Outreach  Enhanced public information  Community partnerships  Realignment of funding priorities

47 Underlying Causes of Disparity  Race  Ethnicity  Gender  Age  Geography  Education

48 Small Steps, BIG Impact

49  Linking potential external partners to SHS programs  Promoting SHS programs that improve the health of racial/ethnic minorities to the health care community, in addition to the public and private sectors  Each Region is addressing problems in their own communities Strategies

50 Texas Public Health Regions

51 Community Outreach Promotora Community Outreach

52 3-Share Plan Health Benefits Package Co-sponsored by the Galveston Chamber of Commerce and the University of Texas Medical Branch Jan-May June July Aug Sep Oct Nov Dec Jan Feb Mar April May June July Aug Sep Oct 2004 2005 Certify and Enroll Business Partners and Patient Base (3000-4000 patient population) Program Development Secure State Approval 3-Share Clinic Start-up 3-Share Clinic Ongoing Service/Evaluation and Policy Development Working Uninsured Project – Access to Health Target low income workers (median in family income $30,000 per year) Premium sharing – employee, employer and government (1/3 each – estimated premium $50-75 per month per individual) Focus on wellness, provide physicals and pharmacy benefits * In Texas, 28% of the population lacks health insurance

53 What TI is Doing Designing disease management programs that have relevance for each employee Participating in a multi-company research project in conjunction with the Washington Business Group on Health to better understand employee perceptions about health care and employees’ experiences with health care providers. The study will help to provide information about correlations between health care delivery and the impact of health care disparity on health outcomes Texas Instruments is focusing on addressing the issue of health care disparity by:

54 What TI is Doing (cont.) Working to use our influence in the local business community to increase awareness of health care disparity. Ultimately we want employers to begin to make specific requirements of health plans/carriers: –1) Diversity of networks –2) Cultural proficiency in the delivery of health education programs –3) Data tracking of disease outcomes based on race

55 What TI is Doing (cont.) Helping to increase the awareness of the need for cultural competency for health care providers Ensuring health plan physician panels have diversity representation Encouraging health plan carriers to begin addressing health care disparities

56 Texas State Strategic Health Partnership Goals  Promoting health nutrition and physical activity  Promoting health choices with regard to risky behavior  Recognizing mental health as a public health issue  Increasing rates of high school graduation, adult literacy and college attendance to improve socioeconomic and health status  Reducing health threats due to environmental and consumer hazards  Reducing infectious disease

57 Texas State Strategic Health Partnership Goals By 2010, Texas state statue and local policy will ensure that essential public health services ( emphasizing disease/injury prevention and health promotion) are available for all communities in Texas. By 2010, a diverse set of governmental and non- governmental partners will actively participate and collaborate to provide the services necessary to meet the public health needs of Texas By 2010, Texas communities will be aware of the structure, function, and availability of the public heath system.

58 Presidential Advisory Commission on Educational Excellence for Hispanic Americans

59 Three Major Strategies Cooperation / Collaboration FOCUS – High Yield Practice Communicate–Communicate-Communicate Do Something About It....wpl Do Something About It....wpl

60 The Health of Texas…

61 …Is up to Us.

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