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1
HEALTH DISPARITIES IMPACTING RACIAL AND ETHNIC MINORITIES IN
MICHIGAN
CONTRIBUTORS: CONTRIBUTORS: BUREAU OF EPIDEMIOLOGY BUREAU OF EPIDEMIOLOGY
BUREAU OF FAMILY, MATERNAL, BUREAU OF FAMILY, MATERNAL,
AND CHILD HEALTHAND CHILD HEALTH
DIVISION OF CHRONIC DISEASE AND DIVISION OF CHRONIC DISEASE AND
INJURY CONTROL INJURY CONTROL
DIVISION OF HEALTH, WELLNESS AND DISEASE DIVISION OF HEALTH, WELLNESS AND DISEASE CONTROL CONTROL
2
To increase awareness of health disparities by collecting and disseminating relevant data
Decrease the burden of disparities by distributing information on public health interventions with proven effectiveness
Establish a systematic approach to collaboration and communication among governmental, private and community based health entities
Leverage resources to initiate new and innovative programs
Purpose of Health Disparities Initiatives
3
“The test of progress is not whether we add more to the abundance of those who have much, it is whether we provide enough for those who have little”
Franklin Delano Roosevelt
Elimination of Health Disparities Became significant concern in 1998Became significant concern in 1998 Six health categories: adult Six health categories: adult
immunization,immunization,
cardiovascular care, cancer care, cardiovascular care, cancer care, diabetes, HIV/AIDS and infant diabetes, HIV/AIDS and infant mortalitymortality
4
What is a Health Disparity?
HealthHealth: A state of complete physical, mental : A state of complete physical, mental and social well-being and not merely the and social well-being and not merely the absence of disease or infirmity. (World absence of disease or infirmity. (World Health Organization)Health Organization)
DisparityDisparity: A chain of events signified by a : A chain of events signified by a difference in (1) environment; (2) access to, difference in (1) environment; (2) access to, utilization of, and quality of care; (3) health utilization of, and quality of care; (3) health status; or (4) a particular health outcome that status; or (4) a particular health outcome that deserves scrutiny.deserves scrutiny.
Carter-Pokras & Baquet, Public Health Reports, Sept/Oct, 2002
5
Health Disparities
Disparities in health, which refer to differences in health outcomes and status; and
Disparities in health care, which refer todifferences in the preventative, diagnosticand treatment services offered to people with similar health conditions, as well as, health care access.
6
Contributing Factors
PovertyPoverty Education LevelEducation Level Cultural Attitudes, Norms, and Values Cultural Attitudes, Norms, and Values Minority Mistrust of Healthcare SystemMinority Mistrust of Healthcare System LanguageLanguage
7
Contributing Factors (cont.)
Provider Cultural CompetencyProvider Cultural Competency
““Health is really a social transaction that has a Health is really a social transaction that has a scientific base. You need to have doctors who have scientific base. You need to have doctors who have the basic knowledge, but that alone is not enough. the basic knowledge, but that alone is not enough. You have to have a physician that is able to You have to have a physician that is able to communicate in a way a patient understands.”communicate in a way a patient understands.”Dr. Louis Sullivan, former U.S. Secretary of Health and Human ServicesDr. Louis Sullivan, former U.S. Secretary of Health and Human Services
Stereotypes held by Healthcare ProvidersStereotypes held by Healthcare Providers Access to Health CareAccess to Health Care
8
Contributing Factors (Continued)
ACCESS to Health CareACCESS to Health Care
45.8 million Americans (15.7% of the total population) 45.8 million Americans (15.7% of the total population) lacked health insurance in 2005.lacked health insurance in 2005.
• Minorities are more likely than whites to be uninsuredMinorities are more likely than whites to be uninsured 32.7% of Hispanics are uninsured32.7% of Hispanics are uninsured 29.9% of Native Americans and Alaska Natives are uninsured29.9% of Native Americans and Alaska Natives are uninsured 19.6% of African-Americans are uninsured19.6% of African-Americans are uninsured 17.9% of Asians are uninsured17.9% of Asians are uninsured 11.3% of white non-Hispanics are uninsured11.3% of white non-Hispanics are uninsured
7.8% of Michigan residents, or almost 800,000 people are 7.8% of Michigan residents, or almost 800,000 people are uninsured at any one time. uninsured at any one time.
State Planning Project for the Uninsured 2005; U.S. Census Bureau 2005
9
“The moral test of government is how it treatsthose who are in the dawn of life, the children;those who are in the twilight of life, the aged; and those who are in the shadows of life, the sick, the needy and the handicapped”
Hubert H. Humphrey
10
Disparities Across the Spectrum
Infant Mortality
Black infant deaths occur
almost 3 times more often than
White infant deaths
Prostate
Cancer
Black male deaths occur
2 times more often than White
male deaths
HIV/AIDS
The rate of HIV infection among Blacks is over 8
times higher than the rate
among Whites
Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
11
Distribution of Michigan's Population Distribution of Michigan's Population by Race/Ancestryby Race/Ancestry
Demographic Profile
Race/AncestryRace/Ancestry 19801980 19901990 20002000 20052005 % Change% Change
WhiteWhite 85.885.8 84.284.2 80.280.2 80.080.0 -6.8-6.8
BlackBlack 13.013.0 14.014.0 14.214.2 14.014.0 7.77.7
American American IndianIndian
0.50.5 0.60.6 0.60.6 0.60.6 20.020.0
Asian/Pacific Asian/Pacific Islander/ OtherIslander/ Other
0.70.7 1.21.2 3.13.1 3.83.8 442.9442.9
Multi-RacialMulti-Racial N.A.N.A. N.A.N.A. 1.91.9 1.61.6 N.A.N.A.
HispanicHispanic 1.71.7 2.22.2 3.33.3 3.83.8 123.5123.5
12
White males White females
Black males Black females
Michigan Life Expectancy
1950 2005
52
57
62
67
72
77
82
52
57
62
67
72
77
82
66.2
60.4
71.9
63.4
75.8
68.0
80.1
75.1
Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
13
0102030405060708090
100
15 20 25 30 35 40 45 50 55 60 65 70 75
Percent Surviving to 65 (2003):
White Female 88.0 White Male 81.5
Black Female 76.9 Black Male 63.4
Age
Perc
en
t S
urv
ival
Survival Curve Ages 15-75 by Sex and Race, Michigan Residents, 2005
Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
14
Racial and Gender Disparities in Selected Risk Factors for Chronic Disease,
Michigan, 2005
Per
cent
of
p op u
lat i
o n w
i th
risk
Source: Michigan Behavior Risk Factor Surveillance System
10.3
27.5
32.936.3
12.5
21.2
38.7
34
8.3
22.326.627.4
7
19.624.2
26.6
0
5
10
15
20
25
30
35
40
45
HBP Diabetes Smoking Obesity
Black Males Black Females White Males White Females
15
Cancer
A diverse group of diseases A diverse group of diseases
characterized by uncontrolled characterized by uncontrolled
growth and spread of abnormal cellsgrowth and spread of abnormal cells
16
Breast Cancer Incidence and Mortality by Race
*Adjusted to 2000 US standard population.
32.9
113.2123.3
23.7
0
20
40
60
80
100
120
140
Incidence 2003 Mortality 2003
BlackWhite
Age
-adj
uste
d ra
te p
er 1
00,0
00*
Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
17
Cervical Cancer Incidence and Mortality by Race
*Adjusted to 2000 US standard population.
3.1
11.7
6.6
1.7
0
2
4
6
8
10
12
14
Incidence 2003 Mortality 2003
BlackWhite
Age
-adj
uste
d ra
te p
er 1
00,0
00*
Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
18
Colorectal Cancer Incidence and Mortality by Race
*Adjusted to 2000 US standard population.
22
55.7
15.2
44.9
0
10
20
30
40
50
60
Incidence 2003 Mortality 2003
Black
White
Age
-adj
uste
d ra
te p
er 1
00,0
00*
Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
19
Lung Cancer Incidence and Mortality by Race
*Adjusted to 2000 US standard population.
94.5
68
54.9
72.8
0102030405060708090
100
Incidence 2003 Mortality 2003
BlackWhite
Age
-adj
uste
d ra
te p
e r 1
00,0
00*
Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
20
Prostate Cancer Incidence and Mortality by Race
*Adjusted to 2000 US standard population.
44.7
273.8
23.6
159.5
0
50
100
150
200
250
300
Incidence 2003 Mortality 2003
BlackWhite
Age
-adj
uste
d ra
te p
er 1
00,0
00*
Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
21
Cardiovascular DiseaseAny disease that affects the heart or Any disease that affects the heart or
bloodblood
vessels by restricting the flow of blood.vessels by restricting the flow of blood.
22Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
Age-Adjusted Stroke Death Rates by RaceMichigan Residents, 1980-2005
0
20
40
60
80
100
120
140
Per
100
,000
Pop
ulat
ion
White
Black
23Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
Age-Adjusted Heart Disease Death Rates by RaceMichigan Residents, 1980-2005
0
100
200
300
400
500
600
Per
10
0,0
00
Po
pu
lati
on
WhiteBlack
24
DiabetesDiabetes A chronic disease characterized by theA chronic disease characterized by theinability to use the glucose in food forinability to use the glucose in food forenergy. energy.
25
Prevalence of Diabetes by Race/Ethnicity, Michigan & U.S.
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005. 002 data; CDC. (2004) National Diabetes Fact Sheet ; Diabetes Care, July, 2003
Race/AncestryRace/Ancestry US 2005US 2005 MI 2005MI 2005
WhiteWhite 6.8%6.8% 7.6%7.6%
BlackBlack 11.4%11.4% 12.0%12.0%
HispanicHispanic 6.6%6.6% 8.5%8.5%
OtherOther 7.2%7.2% 5.0%5.0%
Multi-RacialMulti-Racial 8.3%8.3% 9.6%9.6%
26
Deaths Due to Diabetes per 100K
DeathDeath U.S. U.S. 20032003
MI 2003MI 2003 MI MI 20052005
White - White - PrimaryPrimary
CauseCause
23.023.0 24.224.2 24.724.7
Black - PrimaryBlack - Primary
CauseCause49.249.2 38.438.4 40.040.0
White - Any White - Any MentionMention
N.A.N.A. 74.974.9 76.376.3
Black – Any Black – Any MentionMention
N.A.N.A. 116.8116.8 124.5124.5Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
27
HIV/AIDS
HIV: Human Immunodeficiency VirusHIV: Human Immunodeficiency Virus
Transmission: Unprotected Anal/Vaginal/Oral SexTransmission: Unprotected Anal/Vaginal/Oral Sex Needle Sharing Needle Sharing
Maternal Maternal
AIDS: Acquired Immune Deficiency SyndromeAIDS: Acquired Immune Deficiency Syndrome
28
Prevalence Estimates of Persons Living with HIV/AIDS in MI by Sex and Race as of October 1, 2006
0
1000
2000
3000
4000
5000
6000
7000B
lac
km
ale
s
Wh
ite
ma
les
Bla
ck
fem
ale
s
Wh
ite
fem
ale
s
His
pa
nic
ma
les
His
pa
nic
fem
ale
s
Pre
vale
nc
e E
sti
ma
te
MDCH/Bureau of Epidemiology/HIV/AIDS Surveillance Program
29
HIV Related Deaths in MI, all ages, by Race & Sex, 1990-2005*
050
100150200250300350400450500
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
*
Year of Death
Nu
mb
er
of
De
ath
s
White Males Black MalesWhite Females Black Females
*Deaths for 2005 may be incomplete.
MDCH/Bureau of Epidemiology/HIV/AIDS Surveillance Program
31
Race specific Infant Mortality Rate Michigan compared to US
0
5
10
15
20
25
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Per
1,0
00 li
ve b
irth
s
Black MI Black USWhite MI White US
Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
32
Eliminating Disparities
“We cannot become what we need to be by remaining what we are” Max Depree
33
General Recommendations New knowledge about the determinants of disease
Develop infrastructure capacity of community-based organizations
Programs must emphasize behavioral risk-reduction and other prevention strategies
Communities must assist at-risk individuals in accessing programs designed to diagnose and treat conditions early
Greater role of local leaders including faith-based and fraternal organizations
Community level interventions to promote normative change
Evidence-based strategies
34
General Recommendations (Cont.) Public Health safety net
Integration of healthcare services, one stop shopping Development of comprehensive community health
centers
Comprehensive health screening programs for communities of color
Culturally and gender appropriate skills-building workshops
Mobile Outreach
35
Specific Groups Recommendations1.1. Schools (K-12):Schools (K-12): Add prevention messages to MI Model Add prevention messages to MI Model
for Comprehensive School Health Education for Comprehensive School Health Education Curriculum. Urge the adoption of policies on healthy Curriculum. Urge the adoption of policies on healthy foods and beverages.foods and beverages.
2.2. Higher Education:Higher Education: Increase number of ethnically Increase number of ethnically diverse/culturally competent providers diverse/culturally competent providers (Michigan Diabetes Strategic Plan recommendations, 2003)(Michigan Diabetes Strategic Plan recommendations, 2003)
3.3. Business:Business: Create work-based risk-reduction, screening, Create work-based risk-reduction, screening, self-management education among employer/union self-management education among employer/union groupsgroups
4.4. HealthcareHealthcare: Support programs that serve minority : Support programs that serve minority populations; Promote culturally acceptable prevention populations; Promote culturally acceptable prevention disease managementdisease management
36
Specific Groups Recommendations (Cont.)
5.5. Healthcare OrganizationsHealthcare Organizations: Partner with professional : Partner with professional organizations to improve awareness, knowledge and skills organizations to improve awareness, knowledge and skills among health care providersamong health care providers
6.6. Community OrganizationsCommunity Organizations: Promote messages and use of : Promote messages and use of lay health workers among faith-based and other community lay health workers among faith-based and other community organizationsorganizations
7.7. State Government:State Government: Target funding to reduce health Target funding to reduce health disparities (Michigan Diabetes Strategic Plan disparities (Michigan Diabetes Strategic Plan recommendations, 2003)recommendations, 2003)
8.8. Media’s Role:Media’s Role: Implement statewide public awareness Implement statewide public awareness campaign of health disparitiescampaign of health disparities
37
Of all the forms of inequality, Of all the forms of inequality, injustice in health care is the most injustice in health care is the most shocking and inhumane.shocking and inhumane.
Martin Luther King Martin Luther King Jr.Jr.
38
Health Disparities Work Group
Audrea M. Woodruff, ChairpersonAudrea M. Woodruff, ChairpersonActing Manager, HDRMHActing Manager, HDRMH
Fawzie AhmedFawzie Ahmed Sheila EmbrySheila EmbryRhonda Bantsimba Rhonda Bantsimba Sophia HinesSophia HinesBrandon Boyle Brandon Boyle Jacquetta Hinton Jacquetta Hinton Patricia Brookover Patricia Brookover Erma Leaphart-GouchErma Leaphart-GouchAlethia Carr Alethia Carr Henry MillerHenry MillerJean C. ChabutJean C. Chabut Amy SlonimAmy SlonimRobert Cochran Robert Cochran Debra SzwejdaDebra SzwejdaArthur DavisArthur Davis Jada WilliamsJada WilliamsDaniel Diepenhorst Daniel Diepenhorst Paulette Dobynes Dunbar Paulette Dobynes Dunbar Konrad EdwardsKonrad Edwards
Dr. Kimberlydawn Wisdom, Surgeon GeneralDr. Kimberlydawn Wisdom, Surgeon General
Dr. Kimberlydawn Wisdom, Surgeon GeneralDr. Kimberlydawn Wisdom, Surgeon General