Community Health and Minorities

Chapter 10

Introduction

• Strength of America lies in diversity of people

• Race remains an issue in U.S.

• U.S. population• Majority – white, non-Hispanic (66%)

• Racial or ethnic minorities (34%)

• Minority health – morbidity and mortality of ethnic minorities

• Define morbidity

• Mortality?

U.S. Population by Race/Ethnicity, 2008

U.S. Population Projection by Race/Ethnicity

• Projections in numbers of members of each ethnicity by 2050?

Introduction

• Advances in health gains are not equal in U.S.

• Secretary’s Task Force Report on Black and Minority Health

• Initiative to Eliminate Racial and Ethnic Disparities in Health (Race and Health Initiative)

Disparity

• Compare african american

• Hispanic…define

native american

6 causes of death accounts for 80% of all in minorities

• Infant mortality

• Cancer

• CVD and stroke

• Diabetes

• Homicide and accidents

• Addictive drugs

Age adjusted death rates for selected causes

continued

The index of disparity

• Differences between rates of health status indicators between minoritities and non minorities

• 5 HSIs went up

• 17 went down

Disparity Index

Race and Health Initiative

• 1) to achieve health

• 2) eliminate disparity

• 3) improve all peoples’ health

• It is part of healthy people 2010’s goals

Racial and Ethnic Classifications

• Classifications used to operationalize race and ethnicity

• Challenges with classifications representing diversity of population

• Categories of race are more social than biological

• Self-reported data can be unreliable

• Many nonfederal systems do not collect racial and ethnic data

Races

• American indian or alaskan native

• Asian or pacific islander

• Black

• White

Ethnic groups

a)Hispanic b) non hispanic

Health Data Sources and Their Limitations• Challenges in complete and accurate collection

of racial and ethnic data

• Bias analysis = numerator and denominator issues.. Numbers not exact

• HHS has long-term strategy for improving collection and use of racial and ethnic data

• Important to understand health beliefs of various groups• Heterogeneity within groups

1997 expanded race definition

• 5 categories: separated asian or Pacific islander into

• Asian and Native Hawaiian or Pacific Islander

• Also term latino or hispanic used

• And negro used as well as black or african american

What is black?

• In south africa?

• In australia?

What is a jew?

• In canada or usa ( Lennie Kravitz)

• In germany WW2? (PARENTAGE)

Americans of Hispanic Origin

• Hispanic origin is an ethnicity, not a race• Persons of Mexican, Puerto Rican, Cuban,

Central American, or South American descent, or some other Spanish origin

• Nearly all Hispanics (96%) in the U.S. are classified by race as white

• Educational attainment: a major disparity

• Income: a major disparity

• Health beliefs

Hispanics

• 2008 47 million hispanics ( 15.4% usa)

• Most rapidly growing

• Especially mexican americans

• Hispanics lowest high school achievement levels (57% in 1980 and 75% in 2008)

• Poverty rates = 22%

Black Americans

• Black or African Americans• People having origins in any of the black racial

groups from Africa ( 2008 =12.4% of USA)

• More than ½ live in southern regions of U.S.

• Educational attainment < whites> hispanics

• Income is lowest of all groups!! (24% in poverty)

• Health beliefs and culture

Asian Americans and Pacific Islanders• Now two separate racial groups

• Generally concentrated in the western states

• Educational attainment well off

• Income well off, a BIPOLAR Distribution

• Health beliefs• Variations among the many groups• Generational differences

• Asians 4.4% usa not “Model Community”

American Indians and Alaska Natives

• Original inhabitants of America

• Economically and socially disadvantaged• Relatively poor health status

• Education: low achievment levels

• Income poverty level 25.7%

• Health beliefs• Various tribal groups have distinct customs,

languages, and beliefs• Many share the same cultural values

Native Americans and Health Care

• Many tribes are sovereign nations• Tribes transferred land in U.S. to federal

government in return for provision of certain services

• Indian Health Services (IHS) within HHS• Responsible for federal health services to

Native Americans and Alaska Natives• Goal to raise health status to highest possible

level

Completed High School by Race and Hispanic Origin, U.S.

Real Median Income by Race and Hispanic Origin, U.S.

Poverty Rates by Race and Hispanic Origin, U.S.

Refugees

• Refugees

• Immigrants

• Aliens

• Illegal aliens

• Can be classified into existing racial/ethnic groups; as a single group, present special concerns

• Education, health problems, injuries, employment, etc.

Race and Health Initiative

• Goal to eliminate disparities among racial and ethnic minority populations in six areas of health while maintaining progress of overall health of American people

• Infant mortality

• Cancer screening and management

• Cardiovascular disease

• Diabetes

• HIV/AIDS

• Adult and child immunization

Infant Mortality ( before 1 year old)

• Serious disparity in U.S. among racial and ethnic minorities• Black Americans infant death rate more than

two times that of white Americans• Lack of prenatal care and low-birth-weight

babies

Infant Mortality Rates by Race and Hispanic Origin of Mother, U.S.

Babies of Low Birth Weight by Mother’s Race and Hispanic Origin, U.S.

Cancer Screening and Management

• Incidence and death rates highest among black Americans for various types of cancer• Many disparities attributed to lifestyle factors,

late diagnosis, access to health care

• Less primary and secondary prevention in various minority groups

• 550,000 cancer deaths/year

• Lung ,rectum, colon and prostate cancer

Examples of primary prevention?

• Hint…….lifestyle

• Examples of secondary prevention?

• Hint ……..screening tests

50 to 75 year old fecal occult tests or low endoscopy

Cancer Incidence and Death Rates, U.S., by Cancer Site and Race

Cardiovascular Diseases ( number 1 killer)

• Death rates vary widely among racial and ethnic groups ( coronary and stroke)• Black Americans have higher rates from CHD

and stroke

• Hypertension prevalence as a risk factor varies according to race/ethnicity• Black American tend to develop hypertension

earlier in life than whites; unknown reason

Heart disease per 100000 2006

Diagnosed age adjusted prevalence of hypertension by race

Strokes per 100000 2006

Diabetes

• Overall prevalence has risen in U.S. in recent years• Prevalence in those 20 and older varies in

minority groups

• Increase in age-adjusted death rates in all racial and ethnic groups• Significantly higher in minority groups

• American indians>black>hispanic

Diabetes Age-Adjusted Prevalence by Race/Ethnicity, U.S.

HIV Infection/AIDS

• Proportional distribution of AIDS cases has increased in black Americans and Hispanics and decreased in white Americans• Attributed to higher prevalence of unsafe or

risky health behaviors, and lack of access to health care to provide early diagnosis and treatment

• Since 1981, ½ all AIDS cases are in minorities

Percentages of AIDS by Race/Ethnicity and Year of Diagnosis, U.S.

% HIV/AIDS cases by race 2007

Child and Adult Immunization Rates

• Early childhood immunizations do not vary significantly by race or ethnicity

• Older adult immunization rates are substantially lower in minority groups, even though an overall increase has occurred

Socioeconomic Status and Racial and Ethnic Disparities in Health

• Many factors contribute to health disparities – economic, educational, behavioral, cultural, legal, and political• Socioeconomic status (SES) considered the

most influential single contributor to premature morbidity and mortality• Association between SES and race/ethnicity is

complicated and cannot fully explain all disparity

Indirect causal associations

• Poverty leads to morbidity and mortality

• Circumstances explain most of morbidity issues

• Education

• Income

• Social status

% adults 65 and over with pneumococcal vaccine

Relationship Between Race and Health

Equity in Minority Health

• Simple solutions unlikely

• Solutions to problems for one group may not work for another

• Solutions must be culturally sensitive

Cultural Competence

• A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals, that enables effective work in cross-cultural situations

• Culture is vital in how community health professionals deliver services and how community members respond to programs and interventions

Empowering the Self and the Community

• To enable people to solve their community health problems• Three kinds of power associated with

empowerment• Social – access to “bases”; needed to gain

political power

• Political – power of voice and collective action

• Psychological – individual sense of potency

Discussion Questions

• Why have there been so many changes to racial and ethnic classifications in the United States in recent decades?

• How can community health programs empower minority groups?