1. RACIAL MINORITIES AND HEALTH DISPARITIES By: Vaisali Patel

2. Trivia Time!

3. Can You Guess?  According to the U.S. Census Bureau’s Population Clock, as of January 01, 2013, the population of the United States is:  A) 316, 929, 000  B) 308, 745, 538  C) 272, 690, 813  D) 246, 819, 230

4. Can You Guess?  Minorities make up __________ % of the U.S. population.  25.4  15.8  36.6  51.3

5. Can You Guess?  ___________ are the fastest growing racial group according to recent reports by the U.S. Census Bureau. Hispanics African Americans Native Americans Asians

6. Can You Guess?  True or False?  Among preschool children who were hospitalized for asthma, only 7% of African American and 2% of Hispanic children are prescribed routine medications to prevent future asthma- related hospitalizations, compared to 21% of White children. Boe, G. (2009). The scoreboard on racial and ethnic disparities in hea lth care. Journal of Continuing Education Topics & Issues, 11(1).

7. Can You Guess?  True or False?  Asian American, Hispanic, and African American residents of nursing homes are all far less likely than White residents to have sensory and communication aids, such as glasses and hearing aids.

8. A Glimpse into the Future  It is projected that by 2060, the White population is projected to fall to 43% Minorities will comprise 57% of the population by 2060

9. A Glimpse into the Future  By 2060, the U.S. Census Bureau predicts: Hispanic population would more than double, from 53.3 million in 2012 to 128.8 million in 2060 African American population is expected to increase from 41.2 million to 61.8 million

10. A Glimpse into the Future  By 2043, the U.S. Census Bureau predicts (Cont’d): Asian population is projected to more than double, from 15.9 million in 2012 to 34.4 million in 2060 American Indians and Alaska Natives would increase by more than half from now to 2060, from 3.9 million to 6.3 million

11. A Glimpse Into The Future By 2043, no group will make up a majority.

12. So WHAT is the Problem? Access to insurance Differences in income

13. So WHAT is the Problem? But that isn’t all. Don’t forget the: Physicians Stereotypes Decision-making Hospital Characteristics Quality of Care Cultural and Communication Barriers

14. What is High-Quality Care?  The Institute of Medicine (IOM) states 6 characteristics that must be present in order to be considered as high-quality care: (1) Safe – Care avoids causing injury to patients from the care provided. (2) Timely – Wait times and delays are minimized for those who receive and provide care.

15. What is High-Quality Care?  IOM characteristics (Cont’d): (3) Effective – Services are provided based on scientific knowledge to all who could benefit and are not provided to those who would not benefit. (4) Efficient – Care avoids wasting equipment, supplies, ideas, and energy.

16. What is High-Quality Care?  IOM Characteristics (Cont’d) (5) Patient-Centered – Care is delivered with “compassion, empathy, and responsiveness to the need, values, and expressed preferences of the individual patient” and ensures that patients “have the education and support they need to make decisions and participate in their own care.” (6) Equitable – Care does not vary in quality because of personal characteristics, including gender, ethnicity, geographic location, or socioeconomic status Burstein, H. J., Prestrud, A. A., Seidenfeld, J., Anderson, H., Buchholz, T. A., Davidson, N. E., & Griggs, J. J. (2010). American Society of Clinical Oncology clinical practice guideline: Update on adjuvant endocrine therapy for women with hormone receptor–positive breast cancer. Journal of Clinical Oncology, 28(23), 3784-3796.

17. Quality of Healthcare and Minorities  Safety: Hispanics and Asians are more likely to die from complications in a hospital compared to non-Hispanic Whites.  Safety: In one study, black youths were two times more likely and Hispanic youths were 70 percent more likely than White youths to have restraints upon admission to a psychiatric hospital, even when controlled for psychiatric condition.

18. Quality of Healthcare and Minorities  Timeliness: minorities are less likely to get a same day or next day appointment to see a doctor than whites and are more likely to be unable to get an appointment until six or more days later  Timeliness: Studies have shown that even when age, sex, hospital characteristics, insurance status, and other factors are controlled, minority patients still had longer door-to-balloon times than white patients.

19. Quality of Healthcare and Minorities  Effectiveness: Hispanic and Asian women also have lower rates of mammograms than non-Hispanic white and black women.  Effectiveness: American Indian/Alaska Native women are the least likely of all races and ethnicities examined to have had prenatal care in their first trimester, despite a federal program dedicated to providing health services for American Indians and Alaska Natives.

20. Quality of Healthcare and Minorities  Efficiency: African Americans and Hispanics are more likely than Whites to be hospitalized for diabetes and pediatric asthma.  Efficiency: African Americans also have higher rates of admission to the intensive care unit in their last months of life.

21. Quality of Healthcare and Minorities  Patient-Centeredness: Adults whose primary language is not English are more likely to report that their providers sometimes or never listened carefully, explained things clearly, respected what they said, and spent enough time with them.  Patient-Centeredness: Asian or Pacific Islander hospice patients are least likely to receive end-of- life care consistent with their wishes.

22. Quality of Healthcare and Minorities  Equitable: The quality of care offered should not differ due to the physician’s preconceived assumptions about a particular race or ethnicity, gender, or socioeconomic status.

23. Is this a Public Health issue?  YES! If racial and ethnic disparities in health and healthcare continue unchanged, many more Americans will be at risk of disease and poor quality health care.

24. Quality of Healthcare and Minorities  No matter what the factors may be, morally and ethically, everyone should receive the high-quality healthcare.

25. References  Addressing racial and ethnic disparities in health care. (2013, April). Agency for Healthcare Research and Quality. Rockville, MD. Retrieved from http://www.ahrq.gov/research/findings/factsheets/minority/disparit/index.html  Burstein, H. J., Prestrud, A. A., Seidenfeld, J., Anderson, H., Buchholz, T. A., Davidson, N. E., & Griggs, J. J. (2010). American Society of Clinical Oncology clinical practice guideline: Update on adjuvant endocrine therapy for women with hormone receptor–positive breast cancer. Journal of Clinical Oncology, 28(23), 3784-3796.  Boe, G. (2009). The scoreboard on racial and ethnic disparities in hea lth care. Journal of Continuing Education Topics & Issues, 11(1).  Connolly, C. (2002, March 21). Report says minorities get lower-quality health care. The Washington Post. Retrieved from http://www.healthpronet.org/prog_resources/news_041502a.html  Hasnain-Wynia, R., Baker, D. W., Nerenz, D., et al. (2007). Disparities in health care are driven by where minority patients seek care. Archives of Internal Medicine, 167(12).  Humes, K., Jones, N., & Ramirez, R. (2011). Overview of race and Hispanic origin: 2010. 2010 Census Briefs.  Nhan, D. (2012, May 17). Census: Minorities constitute 37 percent of U.S. population. National Journal. Retrieved fromhttp://www.nationaljournal.com/thenextamerica/demographics/census-minorities-constitute-37-percent-of-u-s- population-20120517

26. References  Rama, P. (2012, March 23). U.S. Census show Asians are fastest growing racial group. The Two-Way. Retrieved from http://www.npr.org/blogs/thetwo- way/2012/03/23/149244806/u-s-census-show-asians-are-fastest-growing-racial- group  Stuart, E., & Betar, T. (2012, June 27). Minorities face hurdles in getting health care. Desert News. Retrieved from http://www.deseretnews.com/article/765586481/Minorities-face- hurdles-in-getting-health-care.html?pg=all  U.S. Census Bureau. (2012). U.S. Census Bureau projections show a slower growing, older, more diverse nation a half century from now. Retrieved from https://www.census.gov/newsroom/releases/archives/population/cb12-243.html  U.S. Census Bureau. (2013). State and county quickfacts. Retrieved from http://quickfacts.census.gov/qfd/states/00000.html  U.S. Census Bureau. (2013). U.S. & world population clocks. Retrieved from http://www.census.gov/main/www/popclock.html