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Recent Federal Initiatives

Gender

SMART Goal

Over the next hour, we will educate our classmates on the health disparities that exist in the US and the prevention strategies that have been implemented.

"The Affordable Care Act will reduce health disparities by investing in prevention and wellness, and giving individuals and families more control over their own care" (HHS Action Plan to Reduce Racial and Ethnic Health Disparities, 2011, p. 7).

http://www.health.harvard.edu/newsletter_article/mars-vs-venus-the-gender-gap-in-health

Healthy People 2020 will be tracking rates of death, chronic and acute diseases, injuries, and other health-related behaviors for the many areas of health disparities

The National HIV/AIDS Strategy looks at decreasing the rate of new cases and providing unbiased care regardless of age, gender, race/ethnicity, sexual orientation, or SES.

Objectives

Sexual Orientation

Interagency Working Group on Environmental Justice addresses adverse environmental health effects on minority and low-income groups.

1. Define what a health disparity is.

2. Identify some of the health disparities that exist in the US.

3. Discuss the implementation strategies that the US has put into place to combat these health disparities.

Sexual health is essential to overall health and well-being, yet sexual health needs often are overlooked. Among racial/ethnic and sexual orientation minorities (ie, gay, lesbian, bisexual and transgender persons), disparities in sexual health exist for problems such as body image dissatisfaction, teen pregnancy and prevalence of sexually transmitted infections such as Chlamydia, Hepatitis C and HIV/AIDS.

  • To effectively address these disparities, healthcare providers must be skilled in discussing sexuality, with respect and sensitivity, in the context of the patient's cultural and sexual identity.
  • In one report, only 35 percent of primary care physicians reported that they often (75 percent of the time) or always take a sexual history.

Efforts to Reduce Disparities in Health

National Institutes of Health (NIH)

  • Establish and maintain ongoing communication and dialogue with under served populations who experience health disparities
  • Develop computer databases and internet resources to disseminate current information about scientific research, discoveries and other activities
  • Develop targeted public health education programs

New Institute created at NIH: National Center on Minority Health and Health Disparities (NCMHD)

  • Furthermore, among racial/ethnic minorities, persons of minority sexual orientation experience increased health risks, higher behavioral risks and lower rates of preventive healthcare than heterosexual men and women.

To overcome this problem, healthcare providers should integrate the sexual history into the medical interview whenever possible to increase their comfort discussing sexuality and sex behavior.

Eliminate Health Disparities

  • Provide latest research-based information to health care providers to enhance the care provided to populations at risk for health disparities

What is a Health Disparity?

Healthy People 2020 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage."

Race/Ethnicity

Evidence of Racial and Ethnic Disparities in Healthcare

What are some of the health disparities that exist in the United States?

Past Federal Initiatives

Evidence of Racial and Ethnic Disparities in Healthcare

American Indians & Alaskan Natives

African Americans

  • Have diabetes rates that are more than two times higher

  • Have disproportionately high death rates from unintentional injuries and suicide

  • Experience a more than double infant mortality rate
  • Have a 30% higher death rate for all cancers
  • Are more than seven times more likely to die from HIV/AIDS
  • Are five times more likely to develop the most common type of glaucoma and are six times more likely to become blind from glaucoma

Community Health Center Program (1969)-improved healthcare access for low-income families in high-need communities

  • Disparities consistently found across a wide range of disease areas and clinical services
  • Disparities are found even when clinical factors, such as stage of disease presentation, age, and severity of disease are taken into account

Asian Americans & Pacific Islanders

Hispanics and Latinos

  • Are almost twice as likely to die from diabetes

  • Accounted for 20% of new cases of TB, despite only comprising 11% of the population in 1996

  • Have higher rates of high blood pressure and obesity

  • Have higher rates of new cases of hepatitis and tuberculosis

  • Demonstrate signs of being a healthy population, on average, but exhibit great diversity within the population. For example, Vietnamese women suffer from cervical cancer at nearly five times the rate of Caucasian women

Have you or anyone you have ever known dealt with or experienced a health disparity?

National Health Service Corps (1972)-works to provide primary medical care in areas designated as Health Profession Shortage Areas

Public Housing Primary Care Program-supports providers in delivering care to residents of public or subsidized housing

What happened and what consequences did it have on them or their family?

Are there ways it could have been prevented?

Health Schools, Healthy Communities Program (1994)-supported development of full-time school-based health centers to serve vulnerable youth

Health Care for the Homeless Program-supports grantees from the community to provide services to homeless population

What is the US government doing to help decrease and prevent these health disparities???

Socioeconomic Status

"Socioeconomic status, whether assessed by income, education, or occupation, is linked to a wide range of health problems, including low birth weight, cardiovascular disease, hypertension, arthritis, diabetes, and cancer. Lower socioeconomic status is associated with higher mortality, and the greatest disparities occur in middle adulthood (ages 45–65)" (Adler & Newman, 2002, p. 60).

Education

Occupation

*shapes future occupational opportunities and potential to earn money

"Lower-status jobs expose workers to both physical and psychosocial risks. They carry a higher risk of occupational injury and exposure to toxic substances" (Adler & Newman, 2002, p. 65).

*higher education levels provide life skills and knowledge that can be used to access better health care and health promotion resources

*The lower the occupational status, the higher percentage of job strain and lack of control over occupation

"Educated adults often have lower levels of stress, maintain larger social networks and live in healthier neighborhoods with more green space and better supermarkets" (Klein, 2014).

No occupation=no employer sponsored healthcare insurance

Income

*people with higher incomes can purchase better healthcare services and can hold health insurance

*higher incomes can provide better nutrition, housing, schooling, and recreation

"Those making less than $24,000 per year suffer from much lower emotional and physical health, have poorer health habits, and have significantly less access to medical care" (Mendes, 2010).

Health Disparities Include:

Questions/comments/concerns???

AIMS OF THE NATIONAL QUALITY STRATEGY

Race

Ethnicity

Immigrant status

Disability

Sex or gender

Sexual orientation

Geography

Income

References

1. Better Care: Improve overall quality, by making health care more patient centered, reliable, accessible, safe, and focused on achieving meaningful health outcomes.

2. Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to delivering higher quality care.

3. Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.

Adler, N. & Newman, K. (2002). Socioeconomic disparities in health: Pathways and policies. Health Affairs, 21(2), 60-76. doi: 10.1377/hlthaff.21.2.60

Harvard Health Publications. (2010). Mars vs. Venus: The gender gap in health. Retrieved from http://www.health.harvard.edu/newsletter_article/mars-vs-venus-the-gender-gap-in-health

The Henry J. Kaiser Family Foundation. (2015). Gender differences in health care, status, and use: Spotlight on men’s health. Retrieved from http://kff.org/womens-health-policy/fact-sheet/gender-differences-in-health-care-status-and-use-spotlight-on-mens-health/

Klein, R. (2014). This is how your education level impacts your health. Retrieved from http://www.huffingtonpost.com/2014/09/26/education-impacts-health-data_n_5871290.html

Mendes, E. (2010). In US, health disparities across incomes are wide-ranging. Retrieved from http://www.gallup.com/poll/143696/Health-Disparities-Across-Incomes-Wide-Ranging.aspx

MSU SSRC. (2012, April 19). Health disparities [video file]. Retrieved from https://www.youtube.com/watch?v=FGeRg8_5TY

NIHOD. (2014, November 5). Social inequalities in health [video file]. Retrieved from https://www.youtube.com/watch?v=roAQHn5rEo

Shi, L. & Singh, D. (2013). Essentials of the U.S. health care system. (3rd ed.). Burlington, MA: Jones & Bartlett Learning.

US Department of Health and Human Services. (2016). 2015 National healthcare quality and disparities report and 5th anniversary update on the national quality strategy. Retrieved from https://www.ahrq.gov/research/findings/nhqrdr/index.html

US Department of Health and Human Services. (2014). Disparities. Retrieved from https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities

US Department of Health and Human Services. (2011). HHS action plan to reduce racial and ethnic health disparities. Retrieved from https://www.minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf

US National Library of Medicine. (2016). Health disparities. Retrieved from https://medlineplus.gov/healthdisparities.html

US Department of Health and Human Services. (2016). 2015 National healthcare quality and disparities report and 5th anniversary update on the national quality strategy. Retrieved from https://www.ahrq.gov/research/findings/nhqrdr/index.html

Health Disparities in the United States

Amanda Richardson BSN, RN, CMSRN

Nouf A. Almsoudi, BSN, RN

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