Behavioral Health Disparities

Behavioral Health DisparitiesLorraine Moya Salas, PhDBianca Altamirano, MSW

1Health DisparitiesThose challenged by poverty experience the poorest health.Racial and ethnic minorities experience poorer health relative to national averages from birth to death Higher infant mortalityHigher rates of disease and disabilityShortened life expectancy

2Health Disparities Health inequalities are a result of both socioeconomic advantage and race/ethnicity independently and in combination. 3The Philadelphia Negro, 1899 One thing of course we must expect to find, and that is a much higher death rate at present among Negroes than among whites. This is one measure of the difference in their social advancement ~ W. B. DuBois~4Health status is a reflection of a myriad of factor including personal choices, historic disadvantage and persistent social inequalities. 5Public Health ModelsConditions that foster disparities: Social determinants of health are life-enhancing resources such as food supply, housing, economic, and social relationships, transportation, education, and health care whose distribution across populations effectively determines length and quality of life. 6Social Determinants

7Whole-Stream Approach Upstream determinants change policies and environmental conditions to promote health.

Downstream determinants interventions Downstream factors such as education are important to change behavior but when delivered alone are unlikely to end population wide health disparities.

Educated about the dangers of tobacco use minimal changes in usage. Taxes on tobaccos and smoke free policies have reduced per capita smoking consumption in Massachusetts and California. Counteradverising --- Still have higher rates of smoking among Hispanic and Asian women.

Downstream interventions nicotine replacement, cessation programs need to be made available to lower income populations.

A broader focus on community conditions that support educational messages and allow people to choose healthy options are essential. 8Behavioral Health DisparitiesBehavioral health disorders are comparable across racial and ethnic groups yet ethnic and racial groups are more adversely impacted by their conditions.

9Behavioral Health DisparitiesAmerican Indians have a heightened risk for PTSD and alcohol dependence.Higher rates of schizophrenia in the African American community.Latino/African American youth have higher rates of PTSD.Higher rates of psychological symptoms 10Roots of disparitiesSocial determinants influence the onset and progression of health and mental health conditions.Environment plays a larger role in the onset of conditionsProgression of conditions are impacted more so by access and quality of care. 11Holistic HealthPhysical health and mental health are interconnected.Emphasis of interventions may differ but to achieve health a state of complete physical, mental, and social well-being and not merely the absence of disease we must attend to social determinants within and outside health care systems.

12Resiliency ParadigmResilience - successful adaptation despite threatening circumstances, wellness in spite of significant risk.13Mental Health Outcomes Risk FactorsProtective FactorsPovertyCommunity disorganization/violenceInadequate schoolsTrauma - racismLow birth weightGenetic vulnerabilityFamily conflictMaternal mental disorderDysfunctional childrearing environment Chronic health conditions

Hope/optimismSocial competenceSupport family relationshipsParental structure/monitoringCaring schoolsAvailability of resourcesSocial normsSense of communitySpirituality/ReligionBicultural orientation14Racism15CIHDR Model16Lack of Access to Quality CareUnderutilization of servicesSocioeconomics (lack health insurance, geographic factors)Provider biasCommunication barriersLack of diversity among providersDistrust, stigma, alternative health practices

17Effective/Promising Interventions Comprehensive community interventionsCommunity Health Workers/PromotorasIntegrated Care/Collaborative Care ModelsCulturally tailored evidenced-based interventions 18Comprehensive Community InterventionsEffective in changing environmental conditions that are linked to chronic physical and mental health conditionsLimited research on effectiveness of specific community interventions. Best available evidence

19Action Model

(Adapted from Healthy People 2020)Place Matters http://www.youtube.com/user/interculturalvideo?blend=4&ob=5#p/u/3/y1SeLM2crUs

21Promotoras/Community Health WorkersLay members of communities who work either for pay or as volunteers in association with the local health care system in both urban and rural environments and usually share ethnicity, language, socioeconomic status, and life experiences with the community they serve. 22ImpactImprove health care access/utilization, increase health knowledge, and the health status of people of color.Play a role in changing community conditions. 23Integrative Care The systematic coordination of physical and behavioral health servicesCo-locationCoordinationEngage consumers in the treatment processEvidence-based guidelines24The Chronic Care Model

25Culturally adapted evidence-based interventionsBoth empirically supported treatments and culturally adapted interventions are effective. Preference findings, engagement, and retention.Cultural considerationsHistorical traumaAcculturation

26Key LearningsWhole-stream interventionsHolistic healthEvidence based practice and culturally adapted/culturally supported interventions

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