Download - 90110 pp tx_ch10
![Page 1: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/1.jpg)
Community Health and Minorities
Chapter 10
![Page 2: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/2.jpg)
![Page 3: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/3.jpg)
![Page 4: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/4.jpg)
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
![Page 5: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/5.jpg)
• Define morbidity
• Mortality?
![Page 6: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/6.jpg)
U.S. Population by Race/Ethnicity, 2008
![Page 7: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/7.jpg)
U.S. Population Projection by Race/Ethnicity
![Page 8: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/8.jpg)
• Projections in numbers of members of each ethnicity by 2050?
![Page 9: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/9.jpg)
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)
![Page 10: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/10.jpg)
Disparity
• Compare african american
• Hispanic…define
native american
![Page 11: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/11.jpg)
6 causes of death accounts for 80% of all in minorities
• Infant mortality
• Cancer
• CVD and stroke
• Diabetes
• Homicide and accidents
• Addictive drugs
![Page 12: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/12.jpg)
Age adjusted death rates for selected causes
![Page 13: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/13.jpg)
continued
![Page 14: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/14.jpg)
The index of disparity
• Differences between rates of health status indicators between minoritities and non minorities
• 5 HSIs went up
• 17 went down
![Page 15: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/15.jpg)
Disparity Index
![Page 16: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/16.jpg)
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
![Page 17: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/17.jpg)
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
![Page 18: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/18.jpg)
Races
• American indian or alaskan native
• Asian or pacific islander
• Black
• White
Ethnic groups
a)Hispanic b) non hispanic
![Page 19: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/19.jpg)
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
![Page 20: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/20.jpg)
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
![Page 21: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/21.jpg)
What is black?
• In south africa?
• In australia?
![Page 22: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/22.jpg)
What is a jew?
• In canada or usa ( Lennie Kravitz)
• In germany WW2? (PARENTAGE)
![Page 23: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/23.jpg)
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
![Page 24: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/24.jpg)
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%
![Page 25: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/25.jpg)
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
![Page 26: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/26.jpg)
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”
![Page 27: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/27.jpg)
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
![Page 28: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/28.jpg)
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
![Page 29: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/29.jpg)
Completed High School by Race and Hispanic Origin, U.S.
![Page 30: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/30.jpg)
Real Median Income by Race and Hispanic Origin, U.S.
![Page 31: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/31.jpg)
Poverty Rates by Race and Hispanic Origin, U.S.
![Page 32: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/32.jpg)
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.
![Page 33: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/33.jpg)
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
![Page 34: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/34.jpg)
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
![Page 35: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/35.jpg)
![Page 36: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/36.jpg)
Infant Mortality Rates by Race and Hispanic Origin of Mother, U.S.
![Page 37: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/37.jpg)
Babies of Low Birth Weight by Mother’s Race and Hispanic Origin, U.S.
![Page 38: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/38.jpg)
![Page 39: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/39.jpg)
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
![Page 40: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/40.jpg)
Examples of primary prevention?
• Hint…….lifestyle
• Examples of secondary prevention?
• Hint ……..screening tests
![Page 41: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/41.jpg)
50 to 75 year old fecal occult tests or low endoscopy
![Page 42: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/42.jpg)
Cancer Incidence and Death Rates, U.S., by Cancer Site and Race
![Page 43: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/43.jpg)
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
![Page 44: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/44.jpg)
Heart disease per 100000 2006
![Page 45: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/45.jpg)
Diagnosed age adjusted prevalence of hypertension by race
![Page 46: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/46.jpg)
Strokes per 100000 2006
![Page 47: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/47.jpg)
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
![Page 48: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/48.jpg)
Diabetes Age-Adjusted Prevalence by Race/Ethnicity, U.S.
![Page 49: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/49.jpg)
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
![Page 50: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/50.jpg)
Percentages of AIDS by Race/Ethnicity and Year of Diagnosis, U.S.
![Page 51: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/51.jpg)
% HIV/AIDS cases by race 2007
![Page 52: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/52.jpg)
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
![Page 53: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/53.jpg)
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
![Page 54: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/54.jpg)
Indirect causal associations
• Poverty leads to morbidity and mortality
• Circumstances explain most of morbidity issues
• Education
• Income
• Social status
![Page 55: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/55.jpg)
% adults 65 and over with pneumococcal vaccine
![Page 56: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/56.jpg)
Relationship Between Race and Health
![Page 57: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/57.jpg)
Equity in Minority Health
• Simple solutions unlikely
• Solutions to problems for one group may not work for another
• Solutions must be culturally sensitive
![Page 58: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/58.jpg)
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
![Page 59: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/59.jpg)
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
![Page 60: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/60.jpg)
![Page 61: 90110 pp tx_ch10](https://reader036.vdocuments.site/reader036/viewer/2022081400/554c8cbfb4c905834a8b57b0/html5/thumbnails/61.jpg)
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?