1. Cultural Diversity
ELDER Project Fairfield University School of Nursing Session 5 – Healthcare Disparities
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

2. Healthcare Disparities
Objectives: Upon completion of this session, the participants will be able to ….
Define ethnocentrism and the implications cultural differences have on healthcare.
Identify factors that contribute to health disparities.
Examine the demographics of these disparities in the local and state area.
Identify cultural competence as an effective strategy to address health disparities.
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

3. Healthcare Disparities
Introduction:
Every culture defines :
what health is for its members
determines etiology of diseases
establishes parameters within which distress is defined
signals and prescribes the appropriate means to treat the disorder.
  Understanding a person’s culture is fundamental to providing medical care.
Contrasting values may result in conflicting expectations of involving others in providing care.
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

4. Healthcare Disparities
Ethnocentrism:
The belief or attitude that one’s own cultural view is the only correct view. It can cause healthcare providers to misinterpret cross-cultural situations, which can:
lead to miscommunication, stereotypes and disrespect
cause a breakdown in the delivery of culturally competent care
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

5. Healthcare Disparities
Racial/Ethnic Composition of Fairfield County, Connecticut:
Source: Fairfield County Quick Facts from the US Census Bureau
That of minority racial/ethnic groups will influence the future health of the U.S. substantially.
Differences in treatment contribute to higher death rates for minorities.
Group
Percentage of Population
White
83%
White/Non-Hispanic
68.5%
Hispanic/Latino
16%
Black/African American
11%
Asian
4.5%
American Indian
0.3%
Pacific Islander
0.1%
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

6. Healthcare Disparities
Health Disparities:
Those avoidable differences in health among specific population groups that result from cumulative social disadvantages.
Population groups experience:
reduced healthcare quality and access
increased rates of disease
disability
death
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

7. Healthcare Disparities
Factors that Affect Health Status and Access to Healthcare:
Socioeconomic position
Income
Housing
Education:
Education and income are both independently linked to health
Death rates from chronic disease, communicable diseases and injuries are inversely related to education.
Education is a benchmark for building literacy skill. Limited education causes a large percentage of adults in the US to have great difficulty successfully performing health-related literacy activities.
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

8. Healthcare Disparities
Factors that Affect Health Status and Access to Healthcare (continued):
Employment
Health barriers
Individual biological susceptibility
Early childhood and familial influences
Access to power/ decision-making/ supportive resources
Racial and ethnic minority Americans are less likely to possess health insurance.
Lack of heath insurance coverage has been identified as the single most important factor in explaining differences between health status of African Americans, Hispanics and Whites.
Minority population groups who are poor, lack resources and have less than a high school education are likely to have limited literacy skills.
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

9. Healthcare Disparities
Health Literacy:
The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.
Healthy People 2010:
People with low health literacy are:
less likely to report poor health,
less likely to have a complete understanding of their health problems and treatments,
at greater risk of hospitalization.
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

10. Facts About Health Disparities
Blacks or African Americans suffer:
worse health outcomes than any other race.
more from major chronic diseases than whites in the following disease categories:
Heart disease………………………………20% higher
Cancer…………………………………………20% higher
Stroke/cardiovascular disease…….30% higher
Diabetes………………………………………3 times higher
HIV/AIDS…………………………………...16% higher
Unintentional injuries………………..40% higher
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

11. Facts About Health Disparities
Hispanics or Latinos are the fastest growing population in the nation and the largest ethnic group in Connecticut. American Indians and Alaska Natives suffer extraordinarily high rates of the following diseases: TB………………………………………..600% higher Alcoholism …………………………..510% higher Motor Vehicle Crashes…………229% higher Diabetes ………………………………189% higher Unintentional injuries…………..152% higher
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

12. Healthcare Disparities
Target Areas for the Elimination of Health Disparities by the US Department of Health and Human Services:
Cancer
Cardiovascular Disease
Infant Mortality
Diabetes
HIV/AIDS
Child and Adult Immunizations
The Connecticut Department of Public Health has added the following to their Surveillance:
Asthma
Obesity
Oral Health
Infectious Diseases and Sexually Transmitted Diseases
Environmental Health
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

13. Cardiovascular Disease
Target Areas from the US Department of Health and Human Services (HHS)
Descriptor from the Connecticut Health Disparities Project (HDP),
CT DPH Fall 2007
Cancer
Significant racial differences in appropriate diagnostic testing and treatment.
Cardiovascular Disease
Minorities are less likely to be given appropriate cardiac medications or to undergo bypass surgery.
African Americans suffer strokes at a 35% higher rate than whites and are less likely to receive major diagnostic and therapeutic interventions.
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

14. Target Areas from the US Department of Health and Human Services (HHS)
Descriptor from the Connecticut Health Disparities Project (HDP),
CT DPH Fall 2007
Infant Mortality
Minority women are less likely to undergo Cesarean sections.
Children are less likely to get prescription medications.
In Connecticut, women in these groups have the highest percentage of late or no prenatal care in the first trimester and the highest rate of low birth weight infants.
Diabetes
Minorities have higher death rate and illness from diabetes.
African Americans are less likely to get key diagnostic tests.
Minorities are more likely to get less desirable procedures, i.e. lower leg amputations.
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

15. Target Areas from the US Department of Health and Human Services (HHS)
Descriptor from the Connecticut Health Disparities Project (HDP),
CT DPH Fall 2007
HIV/AIDS
Minorities are less likely to receive antiretroviral therapy and other state-of-the-art treatment.
In Connecticut, it is more prevalent in Hispanics and Blacks.
Child and Adult Immunizations
The following groups receive influenza vaccine:
48% of African Americans
56% of Hispanics
67% of Whites
The following groups receive the pneumococcal vaccine:
31% African Americans
30% Hispanics
57% Whites
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

16. Connecticut
Asthma
African Americans are less likely to receive appropriate medications to manage chronic symptoms.
Highest incident is seen in Hispanic and Black children.
Obesity
Seen more in lower income groups (less than 25,000/year).
Linked to hypertension, high cholesterol and triglyceride levels, diabetes, heart disease and cancer.
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

17. Connecticut Oral Health
The incidence of tooth decay in kindergarteners and third graders includes:
49.3% Hispanics
43% African Americans
42% Asians
28.9% Whites
Infectious Diseases and STDs
The highest incidence of TB is among Asian residents.
STDs (Chlamydia, gonorrhea, syphilis) are more prevalent in the African American community.
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

18. Connecticut Environmental Health
Hispanics have 2.4 times more non-fatal work related injuries and illnesses than whites.
Blacks and Hispanic residents of all ages have the highest asthma hospital rates (332 per 100,000 populations) than whites (84.5 per 100,000 populations).
Native American children have three times higher lead blood levels than whites.
Blacks have 2.7 times higher levels than whites.
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

19. Healthcare Disparities
Conclusion: Cultural competence is a strategy to improve quality and address disparities. The goal is to provide the highest quality care to every patient regardless of race, ethnicity and culture or language proficiency.
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

20. Reference
CT Department of Public Health. (2009). Facts About Health Disparities in Connecticut, Retrieved October 10, 2010 from
Fairfield County QuickFacts from the US Census Bureau. Retrieved October 16, 2010 from
Heath Disparities Report. (2009). Retrieved October 16,2010 from ct.gov/dph/lib/dph/multicultural_health/2009/ct_healthdisparitiesreport.pdf.
Stratton, A., Nepaul, A,, and Hynes, M. (2007). Issue Brief-Defining Health Disparities.. Retrieved October 10, 2010 from ct.gov/dph/lib/dph/hisr/pdf/defining_health_disparities.pdf.
Stratton, A., Nepaul, A,, and Hynes, M. (2007). Issue Brief-Race and Ethnicity Matters: concepts and Challenges of racial and Ethnic Classifications in Public Health. Retrieved October 10, 2010 from ct.gov/dph/lib/dph/hisr/pdf/race_and_ethnicity_matters.pdf.
Yeo, G. (2010). Culture Med Ethnogeriatrics Overview Introduction. Retrieved November 6, 2010 from
Yeo, G. (2010). Culture Med Ethnogeriatrics Overview Patterns of Health Risk. Retrieved November 6, 2010 from
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

21. Power Point Presentation Created By:
Joyce Cunneen, MSN, RN Fairfield University School of Nursing ELDER Project Education Coordinator Monica Starr, BSN, RN ELDER Project Program Coordinator
Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858