1. Community and Public Health and Racial/Ethnic Minorities
Chapter 10
Community and Public Health and Racial/Ethnic Minorities

2. Chapter Objectives (1 of 2)
After studying this chapter, you should be able to:
Explain the concept of diversity as it describes the American people.
Explain the impact of a more diverse population in the United States as it relates to community and public health efforts.
Explain the importance of the 1985 landmark report, The Secretary’s Task Force Report on Black and Minority Health.
List the racial and ethnic categories currently used by the U.S. government in statistical activities and program administration reporting.

3. Chapter Objectives (2 of 2)
List some limitations related to collecting racial and ethnic health data.
Discuss selected sociodemographic characteristics of minority groups in the United States.
List and describe the six priority areas of the Race and Health Initiative.
Explain the role socioeconomic status plays in health disparities among racial and ethnic minority groups.
Define cultural and linguistic competence and the importance of each related to minority community and public health.

4. Introduction Strength of America lies in diversity of people Diversity
U.S. population
Majority – white, non-Hispanic (62.2%)
Racial or ethnic minorities (37.8%)

5. Racial and Ethnic Classifications
Classifications used to operationalize race and ethnicity
Race – “categorization of parts of a population based on physical appearance due to particular historical social and political forces”
Ethnicity – subcultural group within a multicultural society; six main features

6. Health Data Sources and Their Limitations
Challenges to collection of race and ethnicity data
Unreliability of self-reported data
Classifications are social constructs that change over time and vary across societies and cultures
Biased analysis
HHS – works to increase reliability of data and amount of data collected

7. Americans of Hispanic Origin
Hispanic origin is an ethnicity, not a race
Largest minority group in U.S.
People of Mexican origin largest Hispanic group
Education
Income
Health beliefs

8. African Americans
People having origins in any of the black racial groups from Africa
2nd largest minority group in U.S.
More than ½ live in southern states
Education
Income
Impact of slavery
Health beliefs

9. Asian Americans
Asian Americans – people of Asian descent who trace their roots to more than 20 different Asian countries
Native Hawaiian and Other Pacific Islanders (NHOPI) – peoples of Hawaii, Guam, Samoa, or other Pacific Islands and their descendants
Immigration
Education
Income
Health beliefs

10. American Indians and Alaska Natives
Original inhabitants of America
Many different American Indian tribal groups and Alaskan villages, each with distinct customs, languages, and beliefs
Relatively poor health status
Indian Health Service

11. U.S. Gov’t, Native Americans, and Provision of Health Care
Many tribes are sovereign nations
Tribes transferred land in U.S. to federal government in return for provision of certain services
Indian Health Services (IHS)
Responsible for federal health services to Native Americans and Alaska Natives
Goal to raise health status to highest possible level

12. Immigrant and Refugee Health
Refugees
Immigrants
Aliens
Unauthorized immigrants
Can be classified into existing racial/ethnic groups; as a single group, present special concerns

13. Minority Health and Health Disparities
Federal efforts to eliminate health disparities

14. Race and Health Initiative
Goal: eliminate disparities among racial and ethnic minority populations in six areas
Infant mortality
Cancer screening and management
Cardiovascular disease
Diabetes
HIV/AIDS
Adult and child immunization

15. Infant Mortality
Serious disparity in U.S. among racial and ethnic minorities
African American infant death rate more than two times that of white Americans
Lack of prenatal care
Low-birth-weight babies
Data from Centers for Disease Control and Prevention, National Center for Health Statistics.Mathews TJ, MacDorman MF. Infant mortality statistics from the 2010 period linked birth/infant death data set. Natl Vital Stat Rep 2013;62(8).
Infant mortality rates by race and Hispanic origin of mother: 2000, 2005, and 2010.

16. Cancer Screening and Management
Incidence and death rates highest among black Americans for various types of cancer
Many disparities attributed to lifestyle factors, late diagnosis, access to health care
Less primary and secondary prevention in various minority groups
Data from: Howlader, N., A. M. Noone, M. Krapcho, et al. (eds.). SEER Cancer Statistics Review, , based on November 2012 SEER data submission, posted to the SEER web site, Bethesda, MD.
SEER cancer incidence and U.S. death rates, 2010, by cancer site and race.

17. Cardiovascular Diseases
Death rates vary widely among racial and ethnic groups
Black Americans have higher rates from CHD and stroke
Hypertension prevalence as a risk factor varies according to race/ethnicity
Black Americans tend to develop hypertension earlier in life than whites; unknown reason

18. population, by race and sex, United States, 2014.
Diabetes
Overall prevalence has risen in U.S. in recent years
Prevalence in those 20 and older varies in minority groups
Increase in age-adjusted death rates in all racial and ethnic groups
Significantly higher in minority groups
Data from Centers for Disease Control and Prevention. Age-Specific Rates of Diagnosed Diabetes per 100 Civilian, Non-Institutionalized Population, by Race and Sex, United States, Dec. 2015
Age-specific rates of diagnosed diabetes per 100 civilian, non-institutionalized
population, by race and sex, United States, 2014.

19. ethnicity: 2008–2012, United States.
HIV Infection/AIDS
Proportional distribution of AIDS cases has increased in African Americans and Hispanics
Attributed to higher prevalence of unsafe or risky health behaviors and lack of access to health care to provide early diagnosis and treatment
Centers for Disease Control and Prevention, 2013, April.
Rates of diagnosis of HIV infection among adults and adolescents by race/
ethnicity: 2008–2012, United States.

20. Child and Adult Immunization Rates
Older adult immunization rates are substantially lower in minority groups, even though an overall increase has occurred

21. Social Determinants of Health and Racial and Ethnic Disparities in Health (1 of 2)
Many factors contribute to health disparities
Strong associations between social determinants of health factors and health outcomes
Education, level of income, poverty

22. Health status by race, ethnicity, and income in 2012.
Social Determinants of Health and Racial and Ethnic Disparities in Health (2 of 2)
Data from Centers for Disease Control and Prevention. Use of Race and Ethnicity in Public Health Surveillance. Summary of CDC/ASTDR Workshop. Morbidity and Mortality Weekly Report, 1993, 42(RR-10).
Data from: National Center for Health Statistics. Health, United States, 2012: With Special Feature on Emergency Care. Hyattsville, MD
A framework for understanding the relationship between race and health.
Health status by race, ethnicity, and income in 2012.

23. Equity in Minority Health
Simple solutions unlikely
Solutions to problems for one group may not work for another
Solutions must be culturally sensitive
Must empower individual and communities
Health literacy

24. Cultural Competence
A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals, that enables effective work in cross-cultural situations
Culture is vital in how community health professionals deliver services and how community members respond to programs and interventions

25. Empowering the Self and the Community
To enable people to solve their community health problems
Three kinds of power associated with empowerment
Social – access to “bases;” needed to gain political power
Political – power of voice and collective action
Psychological – individual sense of potency

26. Discussion Questions
Why have there been so many changes to racial and ethnic classifications in the United States in recent decades?
How can community health programs empower minority groups?