1. December 3, 20011 Introduction to Public Health : Minority Health MPH 600 Guest Lecturers L. Robert Bolling, Former Director Henry C. Murdaugh, Director For Christopher Buttery, MD, MPH

2. December 3, 2001September 28, 1998 2 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%)

3. December 3, 2001September 28, 1998 3 Background §1985 Report of the U.S. Secretary of Health and Human Services’ Task Force on Black and Minority Health. §Virginia Minority Health Initiative.

4. December 3, 2001September 28, 1998 4 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

5. December 3, 2001September 28, 1998 5 Virginia’s African-American Health Status Available data for Virginia shows a substantial disparity or ‘gap’ between health indices for Blacks and Whites.

6. December 3, 2001September 28, 1998 6 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.

7. December 3, 2001September 28, 1998 7 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

8. December 3, 2001September 28, 1998 8 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

9. December 3, 2001September 28, 1998 9 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, 1998-2000

10. December 3, 2001September 28, 1998 10 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 94.529.6 White 98.115.3 Total 97.521.5 HP 2K (Black)25.0 HP 2K (All)20.6 Source: Breast and Cervical Program, VDH

11. December 3, 2001September 28, 1998 11 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, 1998-2000

12. December 3, 2001September 28, 1998 12 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

13. December 3, 2001September 28, 1998 13 The Disparity or ‘Gap’ (Children) §Infant Mortality §Low Birth Weight §Teenage Pregnancy §Lead, Asthma §Tobacco Use

14. December 3, 2001September 28, 1998 14 Infant Mortality Rate per 1,000 Live Births Virginia, 1991-1998 Source: Center for Health Statistics

15. December 3, 2001September 28, 1998 15 Resident Low Weight Live Births Percent of Total Live Births Virginia, 1991-1998 Source: Virginia Center for Health Statistics

16. December 3, 2001September 28, 1998 16 Resident Teenage Pregnancies Virginia, 1976-1998 Source: Virginia Center for Health Statistics

17. December 3, 2001September 28, 1998 17 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.

18. December 3, 2001September 28, 1998 18 Reported HIV and AIDS Cases By Race, 1990 to 1997 (Percentage)

19. December 3, 2001September 28, 1998 19 Total Syphilis Cases and Racial Percentage, 1990-1997 YearCases% Black 19901,55191.6% 19911,62290.5% 19921,34792.2% 19931,26891.3% 19941,40990.3% 19951,14491.4% 1996 79890.9% 1997 61588.1%

20. December 3, 2001September 28, 1998 20 African-Americans Eligible for Medicaid, 1996 The Statistical Record of the Virginia Medicaid Program, October 1996

21. December 3, 2001September 28, 1998 21 Percent of Total Uninsured by Race, Virginia 1993 and 1996 JCHC Staff Analysis: ‘93 & ‘96 Health Care Access Surveys

22. December 3, 2001September 28, 1998 22 Percent of African-Americans by Type of Insurance Status JCHC Staff Analysis ‘93 & ‘96 Health Care Surveys

23. December 3, 2001September 28, 1998 23 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

24. December 3, 2001September 28, 1998 24 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?

25. December 3, 2001September 28, 1998 25 Models that Work §Virginia Baptist General Convention Collaborative project with the Virginia Department of Health §African-American Fatherhood Campaign §Alliance of Black Churches

26. December 3, 2001September 28, 1998 26 Why Do these Programs Work? §Adequately Funded: Federal, State, Local and Privately §Community-Based §Culturally Competent §Accessible

27. December 3, 2001September 28, 1998 27 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

28. December 3, 200128 Be Active Now Each One, Reach One Tsamaya Sentle!