UNC 7th Annual Summer Public Health Research Institute on Minority Health UNC 7th Annual Summer Public Health Research Institute on Minority Health William D. Hobson, MS Deputy Associate Administrator, Bureau of Primary Health Care Current Needs and Current Issues in Minority Health Research The People We Are…The People We Serve Chapel Hill, NC June 18, 2001

Need for Minority Health Research  Increasing growth rate of racial/ethnic minorities in the U.S. population  Poorer health status of some racial/ethnic minority populations  Increasing percentage of racial/ethnic minorities of the U.S. population  Poorer health care outcomes of some racial/ethnic minorities  Some of the factors contributing to the poor health status and poor health care outcomes of racial/ethnic minorities are not well understood

General Indicators of Disparate Health Status  Higher rates of morbidity and mortality for African Americans  Native Americans and Hispanics have worse health outcomes than the total population  Some Asian/Pacific Islander subgroups have very poor health status outcomes

Health Disparities A Key Indicator of the Need for Research in Minority Health

HRSA/BPHC Working Definition of a Health Disparity A population-specific difference in the presence of disease, health outcomes, or access to care.

Bases of Health Disparities  Differences in Economic Condition  Differences in Education  Differences in Other Social Conditions  Differences in Environment (Work/Neighborhood/Home)  Genetic Differences

Emerging Research Topics Requiring Further Study  The Provision of Less Optimal Care  Racial & Ethnic Variations in Response to Medical Treatment

Historic Concept of Race in Health Care Research Is Based on Several Flawed Genetic Assumptions  That race is a valid biologic category  That genes determining race are linked to those determining health  That the health of a population is largely determined by the biologic composition of the population

Alternative Multidimensional Concept of Race Is Based on A Socially Constructed Taxonomy  That reflects cultural determinants  That reflects socioeconomic determinants  That reflects Legal determinants  That reflects political determinants  That reflects biologic determinants

Intermediary Factors & Processes Effecting Health of Minorities  Health Practices  Psychosocial stresses  Environmental Stresses  Psychosocial resources  Access to medical care

Assumptions Regarding the Statistical Validity of Racial/Ethnic Data  That racial and ethnic categories and group designations are both consistently defined and consistently ascertained  That the categories and designations are understood by the populations questioned  That the survey enumeration, participation, and response rates are high and similar for all populations  That the responses of persons are consistent in different data sources and at different times

Minority Health Issues  Economic  Geographic  Cultural  Linguistic  Social Issues of Access

Minority Health Issues (cont.)  Infant mortality  Low-weight births  Chronic disease incidence rates  Communicable disease incidence rates Issues of Health status

Minority Health Issues (cont.)  Evidence-based medicine  Cultural competence  Awareness of the patient’s environment (home & work)  Disparities in treatment (provision of less-optimal care)  Disparities in patient care outcomes  Differential response to pharmaceuticals  Racial and ethnic variations in response to treatment  Improving patient education  Changing clinician behavior Issues of Patient Care Quality

Minority Health Issues (cont.)  Predisposition associated with race/ethnicity  Protective factors associated with race/ethnicity Issues of Genetics

Minority Health Issues (cont.)  Analysis of traditional approaches (What works; what doesn’t?)  Analysis of current innovations  Design and testing of new approaches Issues of Prevention

Minority Health Issues (cont.)  Analysis of traditional approaches (What works; what doesn’t?)  Analysis of current innovations  Design and testing of new approaches Issues of Health/Human Services Integration

Minority Health Issues (cont.)  Effect of various market pressures on services to minorities  Effects of changes in the health care marketplace on minorities  Benefits & shortcomings of health insurance on health care access and health status  Health care financing for the poor and underserved  Safety net providers Issues of Health Care Policy

Issues of Cultural Competence  Assessment of the association between cultural competence and improvement in health outcomes  Cost benefit analysis of culturally competent services in ambulatory health care settings  Evaluation of the effectiveness of cultural competence curricula in health professions school  Assessment of community-based education as a tool to teach cultural competence  Does provider-patient racial or ethnic concordance improve patient satisfaction? Minority Health Issues (cont.)

Minority Health Research Challenges  Some members of racial and ethnic minority groups shun participation in research studies because of historical mistrust due to past experiences with racism, bias or exploitation in health care delivery and past health research.  Some racial and ethnic minorities feel that their groups have not benefited from their participation in past research.  Differing values and social, cultural, religious and spiritual beliefs related to health may inhibit certain groups from participating in research protocols or studies.

Minority Health Research Challenges (cont.)  Members of diverse racial and ethnic groups that are fairly new to this country may neither be accustomed nor willing to participate in research conducted according to traditional U.S. methodologies.  Many faculty within institutions of higher education neither use nor teach research methodologies that are culturally competent and use participatory action.  Funders of research have been slow to require principles of cultural competence, participatory action research designs and advocacy- oriented approaches in grants and contracts they support.  There is a need for research to validate the efficacy of culturally and linguistically competent approaches to health care delivery.

In summary there is no shortage of need for minority health research and certainly no shortage of research issues that are pertinent to and vital for racial and ethnic minority populations and researchers.

The People We Are…The People We Serve