December 3, Introduction to Public Health : Minority Health MPH 600 Guest Lecturers L. Robert Bolling, Former Director Henry C. Murdaugh, Director For Christopher Buttery, MD, MPH

December 3, 2001September 28, Minority Populations Demographics Racial and Ethnic Minorities Comprise 24% of the state’s total population §African-Americans/Blacks 1.5 million (20%) §Asian/Pacific Islanders – 248,00,000 (3.6%) §Hispanics/Latinos – 251,000 (3.7%) §Native Americans -- 19,000 (<1%)

December 3, 2001September 28, Background §1985 Report of the U.S. Secretary of Health and Human Services’ Task Force on Black and Minority Health. §Virginia Minority Health Initiative.

December 3, 2001September 28, Virginia Minority Health Initiative §Minority Health Advisory Committee Provides -- Recommendations and information for improving minority health to the Commissioner, VDH, and other agencies and organizations. §Office of Minority Health Provides -- Policy development Resource development Data/Information Technical Assistance

December 3, 2001September 28, Virginia’s African-American Health Status Available data for Virginia shows a substantial disparity or ‘gap’ between health indices for Blacks and Whites.

December 3, 2001September 28, Virginia’s African-American Health Status Indicators §Life expectancy, infant mortality, low birth weight and teenage pregnancy are considered reliable indicators or measures of health status and quality of life. §The burden of chronic disease provides another reliable index for measuring health status.

December 3, 2001September 28, The Disparity or “Gap” (Adults) §Heart Disease §Cancer §Cerebrovascular Disease/Stroke §Diabetes §Unintentional Injuries §HIV/AIDS *State Health Commissioner's Minority Health Advisory Committee, Initial Fact Sheet, 1990

December 3, 2001September 28, Comparison of Life Expectancy by Race, Virginia, 1992 Black life expectancy is six years less than for whites. RaceYears Black71 White77 Total75 Rounded to the nearest year, Center for Health Statistics, Virginia Department of Health

December 3, 2001September 28, Comparison Heart Disease Mortality Rate by Race (age-adjusted/100,000 pop) Virginia, 1995 POPRATE Black186.7 White127.8 Total137.6 HP 2K (Black)115.0 HP 2K (All)100.0 Source: Virginia’s Plan for Cardiovascular Disease Prevention,

December 3, 2001September 28, Comparison Breast Cancer Incidence and Mortality Rates, By Race (age-adjusted/100,000 pop) Virginia, 1994 Although the incidence of breast cancer is comparable across racial populations in Virginia, the Black death rate doubles the white rate. Race IncidenceRate Black White Total HP 2K (Black)25.0 HP 2K (All)20.6 Source: Breast and Cervical Program, VDH

December 3, 2001September 28, Comparison Stroke Mortality Rates by Race (age-adjusted/100,000 pop) Virginia, 1994 POPRATE Black48.2 White25.7 Total29.7 Source: Virginia’s Plan for Cardiovascular Disease Prevention,

December 3, 2001September 28, Comparison of Diabetes-Related Mortality (age-adjusted) by Race, Virginia, 1996 RATE Black74.4 White31.2 Total37.8 Source: Diabetes Control Surveillance Project, Survey and Evaluation Research Laboratory, Virginia Commonwealth University, 1998

December 3, 2001September 28, The Disparity or ‘Gap’ (Children) §Infant Mortality §Low Birth Weight §Teenage Pregnancy §Lead, Asthma §Tobacco Use

December 3, 2001September 28, Infant Mortality Rate per 1,000 Live Births Virginia, Source: Center for Health Statistics

December 3, 2001September 28, Resident Low Weight Live Births Percent of Total Live Births Virginia, Source: Virginia Center for Health Statistics

December 3, 2001September 28, Resident Teenage Pregnancies Virginia, Source: Virginia Center for Health Statistics

December 3, 2001September 28, Childhood Lead Poisoning per 100,000 Children Aged 0-15 By Race Black children are 9.7 times more likely to have lead poisoning than white children.

December 3, 2001September 28, Reported HIV and AIDS Cases By Race, 1990 to 1997 (Percentage)

December 3, 2001September 28, Total Syphilis Cases and Racial Percentage, YearCases% Black 19901, % 19911, % 19921, % 19931, % 19941, % 19951, % % %

December 3, 2001September 28, African-Americans Eligible for Medicaid, 1996 The Statistical Record of the Virginia Medicaid Program, October 1996

December 3, 2001September 28, Percent of Total Uninsured by Race, Virginia 1993 and 1996 JCHC Staff Analysis: ‘93 & ‘96 Health Care Access Surveys

December 3, 2001September 28, Percent of African-Americans by Type of Insurance Status JCHC Staff Analysis ‘93 & ‘96 Health Care Surveys

December 3, 2001September 28, Vignettes §39 yr old Honduran pregnant mother §Employed as housekeeper in local hotel §No insurance §Limited English Proficiency §Goes to local for profit hospital §Blood in stool §54 yr old African- American married male §Diabetic on insulin §Slightly overweight §Manager at local factory §Insured §Blood in stool

December 3, 2001September 28, Discussion Questions? §Is there a difference between community health and minority health? §How can we eliminate health disparity in access to health care? §How is access to health care for minority and underserved populations financed in Virginia?

December 3, 2001September 28, Models that Work §Virginia Baptist General Convention Collaborative project with the Virginia Department of Health §African-American Fatherhood Campaign §Alliance of Black Churches

December 3, 2001September 28, Why Do these Programs Work? §Adequately Funded: Federal, State, Local and Privately §Community-Based §Culturally Competent §Accessible

December 3, 2001September 28, Effective Strategies to Improve Minority Health §Support and Collaborate with Your State Offices of Minority Health §Establish National Umbrella Advocacy Organization with Sole or Primary Focus on African-American Health Issues §Partnership with Other Minority Health Entities §Promote State Legislation Action to Address Minority Health

December 3, Be Active Now Each One, Reach One Tsamaya Sentle!