1. End of Life Care for Racially and Ethnically Diverse Populations End of Life Care for Racially and Ethnically Diverse Populations Gloria Ramsey, JD, RN Associate Professor Graduate School of Nursing Associate Research Professor (nominee) School of Medicine Department of Medical and Clinical Psychology

2. Asked to Consider How to get started with a useful public policy or educational initiative to improve care among underserved populations? How to get started with a useful public policy or educational initiative to improve care among underserved populations? Should the Council begin with a broad public engagement process? How would this best be done? Should the Council begin with a broad public engagement process? How would this best be done? Would it be better to start a discrete project, perhaps something that has been successful elsewhere? If so, what do you recommend? Would it be better to start a discrete project, perhaps something that has been successful elsewhere? If so, what do you recommend?

3. Objectives… How to get started with a useful public policy or educational initiative to improve care among underserved populations? How to get started with a useful public policy or educational initiative to improve care among underserved populations? –Identify healthcare disparities in Maryland among racial and ethnic minorities

4. Racial and Ethnic Health Disparities Racial and Ethnic Health Disparities The problem of racial and ethnic health disparities has been well documented, leading the U.S. Department of Health and Human Services (HHS) to make eliminating health disparities by 2010 a national goal. The problem of racial and ethnic health disparities has been well documented, leading the U.S. Department of Health and Human Services (HHS) to make eliminating health disparities by 2010 a national goal.

5. Recent Headlines… At the End of Life, a Racial Divide At the End of Life, a Racial Divide Minorities Are More Likely to Want Aggressive Care, Studies Show Washington Post March 12, 2007

6. …Recent Headlines… A question of trust A question of trust Hospice programs working harder to serve minority communities The Boston Globe March 26, 2007

7. …Recent Headlines Racial, Ethnic Cultural Differences Affect Minorities Experience with Hospice Care, Report Finds The Los Angeles Times March 16, 2007

8. Much Speculation As to Why...

9. Racial and Ethnic Influences on End-of-Life Preferences… Reluctance of blacks and Hispanics to use hospice services (8% AA) Reluctance of blacks and Hispanics to use hospice services (8% AA) Reluctance of blacks and Hispanics to complete advance directives (20% generally) Reluctance of blacks and Hispanics to complete advance directives (20% generally) Reluctance of blacks and Hispanics to withdraw life- sustaining treatment Reluctance of blacks and Hispanics to withdraw life- sustaining treatment

10. … Racial and Ethnic Influences on End-of-Life Preferences Race/ethnicity is a predictor of end of life decision-making (even when adjust for demographic and socioeconomic status) Race/ethnicity is a predictor of end of life decision-making (even when adjust for demographic and socioeconomic status) Religion/religiosity/spirit- uality associated with measures to prolong life, reluctance to withdraw life support, and disapproval of assisted suicide Religion/religiosity/spirit- uality associated with measures to prolong life, reluctance to withdraw life support, and disapproval of assisted suicide Women are more likely to experience more pain and be undertreated for pain. Women are more likely to experience more pain and be undertreated for pain. Women are less likely than men to prefer and receive aggressive treatment at the end of life Women are less likely than men to prefer and receive aggressive treatment at the end of life

11. Changing Demographics Changing Demographics The demographics of the nation are changing. The demographics of the nation are changing. Past two or three decades remarkable increase in the diversity of our population. Past two or three decades remarkable increase in the diversity of our population. Many people in the United States come from Latin America, Eastern Europe, Southeast Asia, and Africa Many people in the United States come from Latin America, Eastern Europe, Southeast Asia, and Africa People of color make up one-third of the U.S. population, and that proportion is expected to increase to half by 2050. People of color make up one-third of the U.S. population, and that proportion is expected to increase to half by 2050.

13. Cardiac Disease Cancer Screening and Management Diabetes HIV Infections/AIDS Immunizations Infant mortality Minority Populations are Disproportionately Affected

15. Objectives… How to get started with a useful public policy initiative to improve care among underserved populations? How to get started with a useful public policy initiative to improve care among underserved populations? –Leverage and partner with others addressing healthcare disparities in Maryland

16. Office of Minority Health and Health Disparities The Office, located within DHMH, will: Provide public education forums Collect and analyze data Develop a strategic plan Provide grants to community-based organizations Develop outreach to racial and ethnic minority communities Develop a plan to increase racial and ethnic minority health care professionals Assist health care professional schools incorporate courses on health disparities

17. House of Delegates HEALTH & GOVERNMENT OPERATIONS COMMITTEE The Health and Government Operations Committee was created in January 2003. The Committee considers legislation relating to child and elder healthcare; civil rights; emergency medical services health and life insurance; health policy and planning, including facilities, occupations and public health; health and life insurance; procurement; and State government. The Committee consists of twenty-five members. It is supported by six subcommittees: Government Operations; Health Facilities and Occupations; Insurance; Minority Health Disparities; Pharmaceuticals; and Public Health and Long-Term Care. MINORITY HEALTH DISPARITIES SUBCOMMITTEE MINORITY HEALTH DISPARITIES SUBCOMMITTEE The Minority Health Disparities Subcommittee was created in September 2004. MINORITY HEALTH DISPARITIES SUBCOMMITTEE MINORITY HEALTH DISPARITIES SUBCOMMITTEE Appointed by Chair, Health & Government Operations Committee: Shirley Nathan-Pulliam, Chair (410) 841-3350, (301) 858-3350 MINORITY HEALTH DISPARITIES SUBCOMMITTEE Appointed by Chair, Health & Government Operations Committee: Shirley Nathan-Pulliam, Chair (410) 841-3350, (301) 858-3350 MINORITY HEALTH DISPARITIES SUBCOMMITTEE Shirley Nathan-Pulliam MINORITY HEALTH DISPARITIES SUBCOMMITTEE Shirley Nathan-Pulliam Joanne C. Benson Joseph C. Boteler III William J. Frank Sheryl Davis Kohl Sue Kullen Shane E. Pendergrass Joanne C. Benson Joseph C. Boteler III William J. Frank Sheryl Davis Kohl Sue Kullen Shane E. Pendergrass Staff: Erin R. Hopwood (410) 841-3770, (301) 858-3770 Staff: Erin R. Hopwood (410) 841-3770, (301) 858-3770 Copyright © 2006 by USU Center for Health Disparities Research and Education