Minority Health & Health Disparities UCSD School of Medicine Sandra Daley, M.D. May 24, 2005

Objectives  Define health disparities  Provide evidence of health disparities  Describe efforts to reduce health disparities and describe anticipated outcomes of current efforts

Health Disparities  National Institute of Health “Health Disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States”  Health and Human Services Agency One of Healthy People 2010’s overarching goals is to eliminate health disparities.

Leading Health Disparities  Cardiovascular Disease  Cancer  Diabetes  HIV/AIDS  Infant Mortality  Asthma  Mental Health National Institute of Medicine Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

Video Module: Worlds Apart Robert Phillip’s story

Evidence of Racial and Ethnic Disparities in Healthcare  Disparities consistently found across a wide range of disease areas and clinical services  Disparities are found even when clinical factors, such as stage of disease presentation, co-morbidities, age, and severity of disease are taken into account National Institute of Medicine Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

 Across a range of clinical settings including: public and private hospitals teaching and non-teaching hospitals  Disparities in care are associated with higher mortality among minorities (e.g., Bach et al., 1999; Peterson et al., 1997; Bennett et al., 1995) Evidence of Racial and Ethnic Disparities in Healthcare cont.,

At-risk Populations  Rate of suicide in adolescents has tripled in the last 30 years  In San Diego compared to national data, higher percentage of youth report suicide attempts in the last 12 months (YRBS 2003)  Gay adolescents are 2-3 times more likely than peers to attempt suicide  Self-identified GLB youth are at increased risk for mental and physical health problems (Lock J 1999)  Women are at greater risk for Alzheimer disease than men and are twice as likely as men to be affected by major depression

 The Appalachian region suffers an excess in premature deaths (among persons ages 35 to 64) from heart disease, all cancers combined, lung cancer, colorectal cancer, chronic obstructive pulmonary disease, diabetes, and motor vehicle accidents, relative to comparable non-Appalachian U.S. population. At-risk Populations cont.,

African Americans  Experience a more than double infant mortality rate  Have a 30% higher death rate for all cancers  Are more than seven times more likely to die from HIV/AIDS  Are five times more likely to develop the most common type of glaucoma and are six times more likely to become blind from glaucoma

Hispanics and Latinos  Are almost twice as likely to die from diabetes  Accounted for 20% of new cases of TB, despite only comprising 11% of the population in 1996  Have higher rates of high blood pressure and obesity

American Indians & Alaskan Natives  Have diabetes rates that are more than two times higher  Have disproportionately high death rates from unintentional injuries and suicide

Asian Americans & Pacific Islanders  Have higher rates of new cases of hepatitis and tuberculosis  Demonstrate signs of being a healthy population, on average, but exhibit great diversity within the population. For example, Vietnamese women suffer from cervical cancer at nearly five times the rate of Caucasian women

Disparities in Medical Diagnosis and Treatment  Hispanic patients with long bone fractures are twice as likely as non-Hispanic whites to receive no ED pain medication (Todd et al., 1993).  Black patients with long bone fractures are 1.66 times as likely as non-Hispanic white patients to receive no ED pain medication (Todd et al., 2000).  Blacks are less likely to be referred for cardiac catheterization than whites, despite identical clinical presentations and lab/EKG data (Shulman et al., 1999).  Minorities less likely to be screened for cholesterol levels (Naumburg et al., 1993).

Reasons for Disparities in Health

Explanations for Health Disparities  Methodological differences Data collection  Socioeconomic differences Health services access Education and behavior SES and living/working environments  Biological differences Anatomical/physiologic Genetic

Explanations for Health Disparities  Sociocultural differences Patient health-related behavior  Diet  Substance use  Occupation  Leisure activity  Professional Competencies  Patient Explanatory models

Efforts to Reduce Disparities in Health

National Institutes of Health (NIH)  New Institute created at NIH: National Center on Minority Health and Health Disparities (NCMHD)

San Diego EXPORT Center Excellence in Partnerships for Community Outreach, Research on Disparities in Health and Training C OUNCIL C OUNCIL C OMMUNITY C LINICS OF REHDI County of San Diego, HHSA

EXPORT Center Goals  Promote participation of health disparity groups in research, prevention, intervention & dissemination activities  Enhance research on HIV and CVD diseases that targets the African American and Latino populations.  Increase number of scientists, graduate & undergraduate students engaged in health disparities research  Disseminate culturally sensitive information on disease prevention in minority communities via clinics and print media network in San Diego

Health Disparities Education  San Diego EXPORT Centers HD Education Core efforts include: Implement a joint minority health disparities curriculum for UCSD SOM & SDSU graduate students in public health Develop and propose a new curriculum for medical students with an area of concentration and potential dual degree in Health Equity under the University of California PRIME initiative

University of California’s PRIME PRIME – Program in Medical Education  To produce culturally & linguistically competent physicians  To train physicians to address the needs of underserved communities  Expanded medical school enrollment with focused programs of excellence & specialized curricula

UCSD’s PRIME-HEq Program in Medical Education - Health Equity

UCSD PRIME-HEq  Inclusive program that trains physicians to provide better health care services to underserved and at risk populations  Provides a new option for dual degrees in minority health and health disparities  Evolves from community/university partnerships formed over the last two decades

Potential PRIME-HEq Dual Degrees  Public Health  Leadership of Healthcare Organizations  Humanities  Bioengineering  Advanced Studies in Clinical Research  Business Administration  Advanced Studies in Law & Medicine

Benefits of Health Science Pipeline and PRIME-HEq  Attracts a diverse population of highly qualified students  Expands dual degree opportunities  Increases the number of physicians providing services to underserved populations

UCSD Trained Physicians in PRIME  Provide health care to underserved and at risk populations and are excellent clinicians prepared to be: Physician/Advocates, Physician/Scholars, and Physician/Healers

Public & Private Investment to Eliminate Health Disparities  Provide latest research-based information to health care providers to enhance the care provided to populations at risk for health disparities  Introduce science based information into the curricula of medical and allied health professions schools and continuing medical education for health professionals

 Establish and maintain ongoing communication and dialogue with underserved populations who experience health disparities  Develop computer databases and internet resources to disseminate current information about scientific research, discoveries and other activities  Develop targeted public health education programs

Objectives  Define health disparities  Provide evidence of health disparities  Describe efforts to reduce health disparities and describe anticipated outcomes of current efforts

Questions?