Chapter 10 Community and Public Health and Racial/Ethnic Minorities

Introduction Strength of America lies in diversity of people Diversity U.S. population Majority – white, non-Hispanic (63.4%) Racial or ethnic minorities (36.6%)

Racial and Ethnic Classifications Classifications used to operationalize race and ethnicity Race – “categorization of parts of a population based on physical appearance due to particular historical social and political forces” Ethnicity – subcultural group within a multicultural society; six main features

Health Data Sources and Their Limitations Challenges to collection of race and ethnicity data Unreliability of self-reported data Barriers to data collection among health care providers Classifications are social constructs that change over time and vary across societies and cultures Biased analysis HHS – works to increase reliability of data and amount of data collected

Americans of Hispanic Origin Hispanic origin is an ethnicity, not a race Largest minority group in U.S. One of the most rapidly growing ethic groups in the U.S. Education Income Health beliefs

African Americans People having origins in any of the black racial groups from Africa 2 nd largest minority group in U.S. More than ½ live in southern states Education Income Health beliefs

Asian Americans and Pacific Islanders Asian Americans – people of Asian descent who trace their roots to more than 20 different Asian countries Pacific Islanders – peoples of Hawaii, Guam, Samoa, or other Pacific Islands and their descendants Education Income Health beliefs

American Indians and Alaska Natives Original inhabitants of America Relatively poor health status Education Income Health beliefs

U.S. Gov’t, Native Americans, and Provision of Health Care Many tribes are sovereign nations Tribes transferred land in U.S. to federal government in return for provision of certain services Indian Health Services (IHS) within HHS Responsible for federal health services to Native Americans and Alaska Natives Goal to raise health status to highest possible level

Immigrant and Refugee Health Refugees Immigrants Aliens Unauthorized Immigrants Can be classified into existing racial/ethnic groups; as a single group, present special concerns

Minority Health and Health Disparities Minority Health Health Disparities Federal efforts to eliminate health disparities

Race and Health Initiative Goal: eliminate disparities among racial and ethnic minority populations in six areas Infant mortality Cancer screening and management Cardiovascular disease Diabetes HIV/AIDS Adult and child immunization

Infant Mortality Serious disparity in U.S. among racial and ethnic minorities African Americans infant death rate more than two times that of white Americans Lack of prenatal care and low-birth-weight babies

Infant Mortality Rates by Race and Hispanic Origin of Mother, U.S.

Cancer Screening and Management Incidence and death rates highest among black Americans for various types of cancer Many disparities attributed to lifestyle factors, late diagnosis, access to health care Less primary and secondary prevention in various minority groups

Cancer Incidence and Death Rates, U.S., by Cancer Site and Race

Cardiovascular Diseases Death rates vary widely among racial and ethnic groups Black Americans have higher rates from CHD and stroke Hypertension prevalence as a risk factor varies according to race/ethnicity Black American tend to develop hypertension earlier in life than whites; unknown reason

Age-Adjusted Prevalence of Diagnosed or Undiagnosed Hypertension in Adults

Diabetes Overall prevalence has risen in U.S. in recent years Prevalence in those 20 and older varies in minority groups Increase in age-adjusted death rates in all racial and ethnic groups Significantly higher in minority groups

Diabetes Age-Adjusted Prevalence by Race/Ethnicity, U.S.

HIV Infection/AIDS Proportional distribution of AIDS cases has increased in African Americans and Hispanics and decreased in white Americans Attributed to higher prevalence of unsafe or risky health behaviors, and lack of access to health care to provide early diagnosis and treatment

Rates of Diagnoses of HIV Infection among Adults and Adolescents by Race/Ethnicity

Child and Adult Immunization Rates Early childhood immunizations do not vary significantly by race or ethnicity Older adult immunization rates are substantially lower in minority groups, even though an overall increase has occurred

Socioeconomic Status and Racial and Ethnic Disparities in Health Many factors contribute to health disparities Socioeconomic status (SES) considered the most influential single contributor to premature morbidity and mortality Education, level of income, poverty Strong associations between SES factors and health outcomes Relationship can be described as gradient

Relationship Between Race and Health

Health Status by Race, Ethnicity, and Income

Equity in Minority Health Simple solutions unlikely Solutions to problems for one group may not work for another Solutions must be culturally sensitive

Cultural Competence A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals, that enables effective work in cross-cultural situations Culture is vital in how community health professionals deliver services and how community members respond to programs and interventions

Empowering the Self and the Community To enable people to solve their community health problems Three kinds of power associated with empowerment Social – access to “bases;” needed to gain political power Political – power of voice and collective action Psychological – individual sense of potency

Discussion Questions Why have there been so many changes to racial and ethnic classifications in the United States in recent decades? How can community health programs empower minority groups?