Assignment for April 1, 2008

• In class We will watch a Bill Moyers’ documentary, Children in America’s Schools

Mind and Body:Health Disparities in America

March 27, 2008

Health Disparities across the American Population

• “Americans who are members of racial and ethnic minority groups, including blacks or African Americans, American Indians and Alaska Natives, Asian Americans, Hispanics or Latinos, and Other Pacific Islanders, are more likely than whites to have poor health and to die prematurely.” CDC, http://www.cdc.gov/omh/AMH/dbrf.htm

Health Disparities, cont.

• African American women are more than twice as likely to die of cervical cancer than are white women and are more likely to die of breast cancer than are women of any other racial or ethnic group.

• In 2000, rates of death from diseases of the heart were 29 percent higher among African American adults than among white adults, and death rates from stroke were 40 percent higher.

Health Disparities, cont.

• American Indians and Alaska Natives were 2.6 times more likely to have diagnosed diabetes compared with non-Hispanic Whites, African Americans were 2.0 times more likely, and Hispanics were 1.9 times more likely.

Health Disparities, cont.

• HIV infection is the fifth leading cause of death for people who are 25-44 years old in the United States, and is the leading cause of death for African-American men ages 35-44.

• Although African Americans and Hispanics represented only 26 percent of the U.S. population in 2001, they accounted for 66 percent of adult AIDS cases and 82 percent of pediatric AIDS cases reported in the first half of that year.

Source http://www.cdc.gov/omh/AMH/factsheets/hiv.htm

Comparison of black and white death rates(http://www.cdc.gov/omh/AMH/AMH.htm)

Cause of deathBlack mortality rates compared to whites

Infant mortality 100 percent higher

Heart disease 40 percent higher

All cancers 30 percent higher

Prostate cancer 100 percent higher

HIV/AIDS 600 percent higher

Homicide 500 percent higher

Estimated Life Expectancy at Birth in Years(source:

http://www.cdc.gov/nchs/data/dvs/nvsr53_06t12.pdf) Year Sex White Black

2002 Male 75.1 68.8

Female 80.3 75.6

1984 Male 71.8 65.3

Female 78.7 73.6

1944 Male 64.5 55.8

Female 68.4 57.7

Infant mortality rates (the rate at which babies less than one year of age die)

• Infant mortality is used to compare the health and well-being of populations across and within countries.

• The leading causes of infant death include congenital abnormalities, pre-term/low birth weight, Sudden Infant Death Syndrome (SIDS), problems related to complications of pregnancy, and respiratory distress syndrome

Infant mortality rates, cont.

• The US infant mortality rate has continued to steadily decline over the past several decades, from 26.0 per 1,000 live births in 1960 to 6.9 per 1,000 live births in 2000.

• The United States ranked 28th in the world in infant mortality in 1998.

Infant mortality rates, cont.

• Infant mortality among African Americans in 2000 occurred at a rate of 14.1 deaths per 1,000 live births, twice the national average.

• The black-to-white ratio in infant mortality was 2.5 (up from 2.4 in 1998). This widening disparity between black and white infants is a trend that has persisted over the last two decades.

• Source: CDC, “Eliminate Disparitiesin Infant Mortality” http://www.cdc.gov/omh/AMH/factsheets/infant.htm

Infant mortality rates, cont.

• SIDS deaths among American Indian and Alaska Natives is 2.3 times the rate for non-Hispanic white mothers

Why do Minorities have higher morbidity and mortality rates?

• Minorities – have less access to, and availability of, health

services including mental health services. (See http://www.cdc.gov/omh/AMH/factsheets/mental.htm)

– are less likely to receive needed health services, – receive a poorer quality of health care, – are underrepresented in health research and

among health care professionals,– have lower levels of education, and– are more likely to live in poverty

Persons with and without Access to Health Care, 2005

• with health insurance: 245.9 million people (84.3% of the population)

– Employer-based health care (59.5% of the insured)

– Government health insurance programs (27.3%)– Privately purchased policies (9.1%)

• without health insurance: 46.6 million (15.9%)

Source: CPR P60-231, pp.20-25

Access to Health Care, cont.

• Uninsured rates (3 yr avg) in descending order:– Hispanics (32.6%) – American Indians and Alaskan Natives (29.9%) – Native Hawaiians and Other Pacific Islanders (21.8) – Blacks (19.5%)– Asians (17.7%), and – non-Hispanic Whites (11.2%).

Access to Health Care, cont.

• The likelihood of being insured rises with income:– Full-time workers are more likely to be insured than part-time

workers or nonworkers– Children in poverty (19.0%) were more likely to be uninsured

than all children (11.2%)– Children 12 to 17 years were more likely to be uninsured

than those under 12

Source: Economic Report of the President, 2006, p. 85

The Direction of Causality

• Does poverty increase the incidence of disease and result in higher mortality rates?

• Does poor health lead to poverty?

Clearly the answers to both questions is yes. But sorting out the relative importance of poor health as a cause of poverty has proven intractable. How would you design a study to sort this out?