1. Factors Influencing Health HRP 290

2. Determinants of Health Environment Environment Behaviors Behaviors Genetics Genetics Access to and Utilization of Healthcare Access to and Utilization of Healthcare

3. Environment Sanitation Sanitation Air Quality Air Quality War War Urban vs Suburban Urban vs Suburban Factories/Manufacturing Factories/Manufacturing Traffic Traffic Collateral injury Collateral injury Waste Disposal Waste Disposal Anniston, AL– 23% below poverty; 50% make less than $50,000/ $27,385 median (US Census Bureau) Anniston, AL– 23% below poverty; 50% make less than $50,000/ $27,385 median (US Census Bureau)

4. Behaviors Exercise Exercise One study 81% wanted to exercise One study 81% wanted to exercise Barriers? Barriers? Food Intake Food Intake Portion size Portion size Psycho-Social Factors Psycho-Social Factors Cost Cost Life Style Choices Life Style Choices

5. Genetics What are some genetic diseases prevalent in African Americans? What are some genetic diseases prevalent in African Americans? What are the implications of genetic testing as a predicator of potential disease regarding health care usage, employment and cost? What are the implications of genetic testing as a predicator of potential disease regarding health care usage, employment and cost? How does knowing your genetic patterns for disease influence your health care decisions? How does knowing your genetic patterns for disease influence your health care decisions?

6. Access to Healthcare 46 million people uninsured (2006) 46 million people uninsured (2006) 1993/39 million; 1996/41 million; 2003/42 million 1993/39 million; 1996/41 million; 2003/42 million White14.5% White14.5% Black19.4% Black19.4% Hispanic32.7% (US Census Bureau, 2006) Hispanic32.7% (US Census Bureau, 2006) Number expected to increase: Number expected to increase: Unemployment predictions Unemployment predictions Economy decreasing Economy decreasing 72% of those uninsured headed by working person ( www. Marketwatch.com, Aug 2006 ) 72% of those uninsured headed by working person ( www. Marketwatch.com, Aug 2006 ) 75 million people <65 years of age did not have insurance at some time 75 million people <65 years of age did not have insurance at some time 24% without insurance for up to 2years and 65% without for 6months or less 24% without insurance for up to 2years and 65% without for 6months or less

7. When those Uninsured are Sick! 20% not get care for serious problem compared to 3% 20% not get care for serious problem compared to 3% 30% not fill prescriptions compared to 12% 30% not fill prescriptions compared to 12% 39% skipped recommended test/treatment as compared to 13% 39% skipped recommended test/treatment as compared to 13% 13% trouble getting mental health treatment 13% trouble getting mental health treatment

8. Income– direct relationship between health care access and income Income– direct relationship between health care access and income 2006 Median income/Full time/Year around 2006 Median income/Full time/Year around Whites$26,352– below poverty 10.3% Whites$26,352– below poverty 10.3% Black$17,902-below poverty 24.3 Black$17,902-below poverty 24.3 Hispanic$15.421-below poverty 20.6 Hispanic$15.421-below poverty 20.6 Transportation Transportation Closing of Urban and Historically Black hospitals Closing of Urban and Historically Black hospitals Only one remains– Howard University Hospital Only one remains– Howard University Hospital Location of care Location of care Access to Healthcare 2006 Census Bureau

9. Location of Care Physician’s Office Physician’s Office Whites 60.6% Whites 60.6% African Americans 49% African Americans 49% ER/Clinic ER/Clinic Whites 11.8% Whites 11.8% African Americans 22% African Americans 22% Days in Hospital Days in Hospital African Americans 1.7X longer than whites African Americans 1.7X longer than whites Why is this significant? Why is this significant?

10. Life Expectancy Life Expectancy African American Males 69 years; white 6 years more African American Males 69 years; white 6 years more African American Females 76years; white 4 years more African American Females 76years; white 4 years more Mortality-Norfolk Mortality-Norfolk Prostate CA– AA 82.2%/W 37.4% Prostate CA– AA 82.2%/W 37.4% Breast CA- AA 52.5%/W 30.2% Breast CA- AA 52.5%/W 30.2% Infant Mortality - AA 16.9%/W 7.6% Infant Mortality - AA 16.9%/W 7.6% New AIDS cases - AA 66.8%/W 30.0% New AIDS cases - AA 66.8%/W 30.0% Level of Health Care Coverage Level of Health Care Coverage Minorities enrolled in lower cost/less coverage plans Minorities enrolled in lower cost/less coverage plans Cultural Issues Cultural Issues Home Remedies Home Remedies Linguistic Barriers Linguistic Barriers Fewer Minority HCP Fewer Minority HCP Health Belief Health Belief

11. Utilization of HealthCare Institutional Racism Institutional Racism HCP Bias HCP Bias Survey found physicians rated African American patients: Survey found physicians rated African American patients: Less intelligent Less intelligent Less educated Less educated More likely to abuse drugs and alcohol More likely to abuse drugs and alcohol Less likely to comply with medical advice Less likely to comply with medical advice

12. Other Evidence Of 9 hospital procedures, 5 were less common among African Americans Of 9 hospital procedures, 5 were less common among African Americans African Americans 13% less likely to undergo coronary angioplasty and 33% less likely for by pass surgery African Americans 13% less likely to undergo coronary angioplasty and 33% less likely for by pass surgery 7% of African American children with asthma prescribed routine preventative medication as compared to 21% in white children 7% of African American children with asthma prescribed routine preventative medication as compared to 21% in white children African Americans with AIDS less likely to get antiretroviral therapy African Americans with AIDS less likely to get antiretroviral therapy African Americans less likely to have assistive devices African Americans less likely to have assistive devices Even with similar economic backgrounds and symptoms, African American women get less referrals Even with similar economic backgrounds and symptoms, African American women get less referrals Http://www.ahrq.gov/research/disparit.htm

13. Utilization of HealthCare Fear Fear Of what you are going to hear! Of what you are going to hear! Fears of the Elderly Fears of the Elderly Danger in getting to the HCP Danger in getting to the HCP Getting back from the HCP Getting back from the HCP Not being able to pay Not being able to pay Being a burden on friends and family Being a burden on friends and family Other Fears Other Fears Historical Influence---Organ, bone marrow and blood donation Historical Influence---Organ, bone marrow and blood donation