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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reference CT Department of Public Health. (2009). Facts About Health Disparities in Connecticut, 2009. Retrieved October 10, 2010 from www.ct.gov/dph/lib/dph/hisr/pdf/facts_cthealth_disparities_2009.pdf.   Fairfield County QuickFacts from the US Census Bureau. Retrieved October 16, 2010 from Http://quickfacts.census.gov/qfd/states/09/09001.html. 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 http://geriatrics.stanford.edu/culturemed/overview/introduction/. Yeo, G. (2010). Culture Med Ethnogeriatrics Overview Patterns of Health Risk. Retrieved November 6, 2010 from http://geriatrics.stanford.edu/culturemed/overview/health_risk_patterns/. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

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