© 2010 Jones and Bartlett Publishers, LLC Health Disparities: The Nebraska Perspective Chapter 15

© 2010 Jones and Bartlett Publishers, LLC Health Disparities: The Nebraska Perspective  Who are the “Cornhuskers?” Healthy People2010 : Increase quality of healthy live and REDUCE health disparities Nebraska Healthy people 2010 Nebraska Office of Minority Health: 2003 Health Report and 2006 Strategic Plan Health Facts for racial/ethnic minorities web- resources

© 2010 Jones and Bartlett Publishers, LLC Health Disparities: The Nebraska Perspective Nebraska is cultural diverse: German, Irish, English, Swedish and Czech. New input with Hispanic or Latinos, AA, NA, Asian American, Africans This diversity produce varying colors, culture and languages Growing Hispanics and Asian communities : 30% from 2000 to 2006 FAIR(2005) foreign-born residents, 5.2% of all NE population

© 2010 Jones and Bartlett Publishers, LLC Health Disparities: The Nebraska Perspective  Health Disparities in Nebraska Maternal and Child Health: Infant mortality  AA 2.9 times more than Whites  NA 2.5 times more than Whites  Latino Children are less likely to be immunized than non Hispanic children Life expectancy and years of potential life lost:  Life expectancy at birth for NA 67.9 years, 71.6 for AA and 78.3 for White non Hispanics

© 2010 Jones and Bartlett Publishers, LLC Health Disparities: The Nebraska Perspective  Access to Care and Poverty : % Hispanics adults with no insurance  36.8 % for NA  22.6% for AA  20.3% NA Adults unable to see a doctor in 12 mo  18.3% For Hispanics  15.6% for AA

© 2010 Jones and Bartlett Publishers, LLC Health Disparities: The Nebraska Perspective  Poverty level in Nebraska is 34% for AA and 26% for Latino  people under age of 65 are uninsured  27% total Latino population is uninsured  NA have increase risk for Diabetes and mortality due to hear disease  AA highest rate of mortality for cancer  47.9% NA smoking and 20.5% Whites  Latino population has increase prevalence in asthma, COPD, HIV, obesity, suicide, teen pregnancy and TB

© 2010 Jones and Bartlett Publishers, LLC Health Disparities: The Nebraska Perspective  What is Nebraska’s Commitment Today? What Are We Doing? Public Health Stakeholders in NE have urged Health Disparities and Profession Associations to be aware of Cultural Competencies  Increase Surveillance, surveillance of language needs, quality of care, cultural barriers, best health practices  In 2006 The office of Minority Health established the medical translation and interpretation program

© 2010 Jones and Bartlett Publishers, LLC Health Disparities: The Nebraska Perspective  State Financing for Nebraska Public Health 2001 : Nebraska legislature passed the Nebraska Health Care Funding Act, Legislative Bill million to found several public Health initiatives  Nebraska’s Office of Minority Health and Health Disparities Created in 1992 Health Department bureau and Health Policy and planning

© 2010 Jones and Bartlett Publishers, LLC Health Disparities: The Nebraska Perspective  Need for Public Health Leadership Leaders to reduce persistency of disparities Cultural competencies Economic-social cost Recruiting and retaining employees in the Health Department WHO? Increase access to Health care with quality for any race or minority group

© 2010 Jones and Bartlett Publishers, LLC Health Disparities: The Nebraska Perspective  Health Education of Racial/Ethnic Minorities Bilingual guides Community Health workers Partnerships Health educators

© 2010 Jones and Bartlett Publishers, LLC Health Disparities: The Nebraska Perspective  Obstacles Lack of cultural understanding Language barriers Poverty Limited resources Public policies Cultural differences Legal status Health education

© 2010 Jones and Bartlett Publishers, LLC Health Disparities: The Nebraska Perspective  Who can help?  OMH (Offc of Minority Hlt) Focus groups multiple ideas Multiple opportunities Open mind

© 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective Chapter 16

© 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective  The Emergence and Growth of the City of St. Louis  St Louis was the 8 th largest City in US, now is the 50 th,  Health disparities  Indicators like life expectancy, infant mortality, maternal mortality, HIV, AIDS, STD : bad outcomes  Multiple ethnicity: Founded in Trade Center 1847 Laws against education for Blacks 1875 High School education for Black children Currently still controversies about quality of education in minority population

© 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective  Health Disparity in St. Louis: How Did It Happen?  The Genesis of Disparities AA are largest group in St. Louis. Poor health outcomes: lifestyle factors, AA identity theory  Multiples theories: Defective gene hypothesis Ghetto miasma hypothesis Social factors : income, education, occupation, family status, coping with stress

© 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective  Financial Disparities CEO $ 3.13 millions vs. Average worker $37.900

© 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective  The question of Racism American theory : all men were created equal major interracial disturbances 1991 TV documentary with several disparities seen. Association of racism with disparate health care outcomes

© 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective Dred Scott Emancipation Proclamation Black H.S. RiotWW II DesegregationRace Docume ntary

© 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective  Education and its role on healthcare disparities in St. Louis Public School Board : very little progress toward excellence in education for all Poorly outcomes Poor leadership? Poor health literacy

© 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective  Cultural Proficiency in Clinical Medicine Cultural competency: success of outcome Cultural competency interview requires patience, make pt comfortable, knowledge, attitude, skill to assure that their interpretation of circumstances and their beliefs system will be accepted and respected

© 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective  The St. Louis Perspective: How Can We Make It Better? Challenge how to educate professionals and provide them with skills, attitude, and knowledge to provide culturally competent care Medical Schools leadership, change of attitude needed and better understanding of health disparities Current practitioners should strive to understand their own weaknesses of cultural proficiency Increase admission of minorities in Medical Schools Capitalizing the presence of AHEC (area hlt ed ctr) Local medical societies take ownership of programs in Health disparities to educate professionals

© 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective

© 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective  Summary Commitment from the City and the government Government as a Stakeholder Weekly teaching, programming, health education, emergency preparedness, and dissemination of other important health information for the public Need for resources Community has resources Multidisciplinary team effort

Federal Programs  The Centers for Disease Control and Prevention tries to address such disparities through its REACH program, short for Racial and Ethnic Approaches to Community Health. The program this year awarded grants to 40 organizations in 22 states. © 2010 Jones and Bartlett Publishers, LLC

REACH  REACH was established in 1999 and helps local programs decrease disparities in six key health areas: heart disease, diabetes, breast and cervical cancer, immunizations, infant mortality and HIV/AIDS. © 2010 Jones and Bartlett Publishers, LLC

REACH  It focuses on five racial and ethnic groups: African-Americans, Hispanics/ Latinos, Asian-Americans, Hawaiians/Pacific Islanders and American Indians/Alaska Natives. © 2010 Jones and Bartlett Publishers, LLC

REACH  A competitive application process attracted nearly 200 proposals and yielded 40 REACH grantees, which will be funded for five years. California has the most grantees with seven projects split between Los Angeles and San Francisco. Massachusetts and New York each have four. © 2010 Jones and Bartlett Publishers, LLC

REACH  Twenty-two of the grantees, including the Community Health Councils in Los Angeles, are funded as Action Communities by the CDC to implement and evaluate proven approaches targeted to specific population groups. In addition to the six key health areas previously mentioned, REACH communities will also address additional conditions contributing to health disparities, including hepatitis B and asthma. © 2010 Jones and Bartlett Publishers, LLC

REACH  The 18 other REACH grantees will establish Centers of Excellence in the Elimination of Health Disparities, which are resource centers that will disseminate information on practices that work and train new communities to follow in the footsteps of successful ones. These centers draw on significant expertise with specific ethnic populations. © 2010 Jones and Bartlett Publishers, LLC

Centers of Excellence for the Elimination of Health Disparities (CEED) © 2010 Jones and Bartlett Publishers, LLC

Action Communities (AC) © 2010 Jones and Bartlett Publishers, LLC

Successes  A CDC survey found many previously funded REACH community initiatives were successful in decreasing health disparities.  Among the survey results:  The cholesterol screening rate for African- Americans in REACH communities exceeded the national level in 2006, after being below the national average in © 2010 Jones and Bartlett Publishers, LLC

Successes  The cholesterol screening rate for Hispanics in REACH communities continues to increase at a time when the rate for Hispanics across the U.S. is steadily decreasing. © 2010 Jones and Bartlett Publishers, LLC

Successes  The blood pressure screening rate for American Indians from REACH communities in 2004 was higher than the rate for American Indians across the nation.  The rates of cigarette smoking among Asian men from REACH communities decreased from 42 percent in 2002 to 20 percent in © 2010 Jones and Bartlett Publishers, LLC