Reducing/Eliminating Health and Disease

Disparities

September 6, 2005

Healthy Kansans 2010

Workgroup Results

Overview

Workgroup Charge

Disparities

Workgroup Guiding Principles

Cultural Competence

Overview of Recommendations

Selected Action Steps and Illustrations

Workgroup Charge

Develop recommendations for major policy and system changes...

Can be implemented by public, private and/or non-profit sectors

Will lead to substantial changes in the social determinants of health (e.g., low education and poverty) among Kansans

Will impact two or more of the ten HP2010 Leading Health Indicators

Workgroup Charge, continued

At a minimum, consider these issues/needs: Racial and ethnic disparities Economic-related disparities, including disparities

related to income and insurance/health benefit coverage Geographic disparities, including disparities affecting

rural populations, service and provider shortages and misdistributions, and current policies and programs that negatively impact on rural populations

Age-related disparities, including system biases that inhibit the participation of older adults in health/disease care and personal biases that inhibit older adults from seeking out health/disease services

Workgroup Charge, continued

Recommendations may be developed to include any of the following areas, as appropriate:

Overall recommendations for change Recommendations that address improved integration

and/or better interface of existing initiatives Recommendations for public communications Recommendations for improving surveillance and

meeting data needs Recommendations for enhancing the current

workforce Recommendations that are highly targeted towards a

specific populations and/or which address multiple populations in a blanket approach

Disparities

Scope of underrepresented groups was broad, consistent with Steering Committee charge:Racial/ethnic minoritiesPersons with disabilitiesSenior adultsGeographic disparitiesSocioeconomic disparitiesGender disparities

Note persons with disabilities were included

“Current data indicate that health disparities between people with and without disabilities are as pervasive as those recognized between ethnic and minority groups.”

(CDC Healthy People 2010 website, http://www.cdc.gov/ncbddd/dh/disparitiesinhealth.htm)

Workgroup Guiding Principles

Underrepresented groups have benefited less from prevention, early detection, and treatment of diseases than U.S. population as a whole.Example: Study of Special Olympics athletes: 1/3 aged 8 to 17 years had never had an eye exam 14% required urgent dental care 40% were overweight or obese Survey: More than half of medical school deans and dental

school deans said that their graduates were “not competent” to treat patients with intellectual disabilities.

“This population is not on the public health radar screen.” Dr. Stephen Corbin, dean of Special Olympics University and director of Health & Research Initiatives

Workgroup Guiding Principles

Lower socioeconomic and education levels, inadequate and unsafe housing, racism, lack of access to care, quality of care, and living in close proximity to environmental hazards disproportionately affect these populations.

Examples of African American (AA) vs. White Kansas Population: 23% vs. 8% below poverty 38% vs. 15% children under 5 below poverty 15% vs. 27% are college graduates 15% vs. 8% are uninsured (State Insurance Commissioner’s Office, 2001)

15% vs. 5% are in housing unit with no vehicle

Sources: 2000 U.S. Census, unless otherwise indicated

Photo Source: AP PhotosQuote Source: “Speak Out (1)”, “Nobody Left Behind: Disaster Preparedness for Persons with Mobility Impairments”, http://www.rtcil.org/NLB_home.htm

Disproportional Affect…

“[After a hurricane], I did not use the shelters, because they were not wheelchair accessible, and had no provisions for my service dog.” - Miami, FL

Workgroup Guiding Principles:Towards Meaningful Change… Need better understanding root causes of disparities

while trying to develop interventions to eliminate Policy-makers from multiple sectors must come

together (economic, educational, health, housing, criminal justice, environmental)

All programs must build on self-identified community assets and be community-driven

Relevant, clear information derived from better data will help communities identify ways to impact health.

Social issues, social systems, and social change must be addressed

Planning framework should include organizational, structural, and clinical cultural competence interventions

We will do little to address disparities among groups – racial, ethnic, underrepresented, historically marginalized – if we don’t squarely address social issues, social systems and social change.

“…we will do little to address disparities among groups – racial, ethnic, underrepresented, historically marginalized – …if we don’t squarely address social issues, social systems, and social change. While these transformational events won’t ‘spring’ from better data, they can not happen, perhaps as quickly, perhaps at all, without it.

“Relevant, clear information derived from (better) data surely will help local communities identify ways to work to improve the health of their citizens as it will also surely help us as a society support leaders who want to improve civic engagement and lead social change. For these reasons, the paramount focus in my view should be on data and communities, first and foremost.

“In addition, …like-minded, health-focused individuals and institutions cannot alone work to dismantle the social forces that shape and perpetuate disparities. Rather, …each and every recommendation must be approached with partnerships among all sectors of society. Until that gathering force unites and takes stock of the depth and breadth of disparities as it affects all aspects of society, I fear we will continue to work at the fringe and will make little headway in reducing and ultimately eliminating health disparities.” - comment received from Disparities workgroup member, Kim Kimminau

Context for All Recommendations:Cultural Competence Definitions Cultural competence: Having the capacity to function

effectively as an individual and an organization within the context of the cultural beliefs, behaviors and needs presented by consumers and communities. An ability to understand and relate to others in a trustworthy manner, with respect for individual cultural differences.

Achieving cultural competence is a process rather than just an outcome.

Achieving cultural sensitivity and cultural specificity are related, incremental steps.

Cultural Competence

Cultural sensitivity: The ability to be appropriately responsive to the attitudes, feelings, or circumstances of groups of people that share a common and distinctive racial, national, religious, linguistic or cultural heritage

Cultural specificity: The creation of an environment in which the identify and experiences of people in a specific group or culture are recognized, explored, and accepted. Related to health promotion and prevention, participants see their culture and images of themselves represented in the prevention message or program.

Example: Farmworker Health ProgramHelen is 24 and pregnant with her fourth child. She is a member of

a religious group that believes in an agriculturally-based life and discourages formal education. She does not speak English is not able to read or write in any language. She has not had much experience with preventive health services.

A bilingual (English/Plautdietsch) health promoter, whose family originates from the same group, helps Helen find low cost prenatal care, and helps her to understand the importance of spacing children and planning her family, within the context of Helen’s religious and cultural beliefs. The Health Promoter also gives her an audio CD that has several other health education topics in her own language, developed for her specific cultural/linguistic group.

Framework for Recommendations

Systems-level changes for three interrelated issues:

Improved cultural competency across

multiple sectors

Engaged communities and leaders

Coordinated, comprehensive, full-

implemented data and evaluation strategy

Recommendations

Invest in community capacity-building, utilizing self-identified community assets to promote planning, implementation, and evaluation of community-based interventions, which address health disparities.

Develop a coordinated, statewide strategy regarding collection, dissemination and utilization of health data and promote participatory evaluation practices.

Promote cultural sensitivity, specificity, and competency through adoption of policies and actions at multiple levels, including professional, organizational, and system.

Selected Action Steps

Refer to handout with recommendations, strategies, and action steps in context

All are interrelated Workgroup members were asked to vote and provide

comments on their “top 10” action steps, based on those that would have the most impact on the 10 Leading Health Indicators

All action steps received votes Action steps with the most votes tended to be “first

steps” in achieving the recommendations and strategies chosen by the group

Selected Action Steps

Page 5, I.A.1. Hold a series of problem-posing sessions…

“This step…is a block-building step for adoption of community-based model. The essence of this model is to listen to the communities for not only identifying the issues but also to identify solutions. This is important because the best way to address community issues is to give charge to the community to make change…. This step will lead to paradigm of ‘thinking with the community’ rather than ‘thinking for the community’.” – Ghazala Perveen

Selected Action Steps

Page 5, I.A.5. Provide opportunities for community-level leaders to participate in leadership development programs…

“If leaders can be plugged into existing training…they can better understand state agency needs and perspectives as well as inform their peer leaders.” – Suzanne Hawley

Page 5, I.A.6. “Involve ethnic minorities and other underrepresented groups…in state-level advisory boards.”

Selected Action Steps

Page 6, I.C.2. Provide opportunities for funders to dialog with one another and with grantees and underrepresented groups…

“…it’s not enough to say that disparities will be effectively dealt with if communities are involved in the planning, implementation, and evaluation…. [That] is only a small step if the money to support that strategy is not there or if we keep funding the same strategies that created the disparities in the first place.” – Henri Ménager

“Open communication leads to maximum community benefit.” – Bev White

Selected Action Steps

Page 6, II.A.1. Build on information gathered and

lessons learned in the minority health disparities

project, specifically, identify data inventory, gaps, and

opportunities for improved data services…

“Utilizing existing data and building from there to

bridge the gaps in availability of data related to health

issues for minorities & underrepresented groups is a

key step…forward in the direction of addressing

health disparities.” – Ghazala Perveen

Selected Action Steps

Page 7, II.A.2. Promote use of technology to address

data gaps and, needs and opportunities to exchange

data….

“We must have data to demonstrate disparities to

make our case for funding, to evaluate trends in

improvement or deterioration, and to measure the

impact of interventions or changes in the

environment.” – Cyndi Treaster

Selected Action Steps

Page 7, II.B.4. “Promote collection of at least race,

ethnicity, primary language, place of birth, disability

status, and income level…. Develop an operational

definition for each standard data element….

“This data is needed for multiple agencies to

collaborate and provide the ‘entire picture’ of various

health problems. Also, consistent data with the same

operational definition is important.” – Catima Potter

Selected Action Steps

Page 8, III.A.1. Develop and implement a plan for

professional and community education in cultural

competency….

“Promote equality of persons in health care settings,

therefore more equality in their treatment and self-

direction for personal health – addresses all leading

health indicators.” – Sister Janice Thome

Example: Socioeconomic Disparity

“Most medical personnel accept that parents know what is and is not normal for their children and act upon the parents’ suggestions. When Mary, a shy 16-year-old single mother, told the ER doctor that her son was crying more than usual since he fell, the doctor did a quick check and sent them home. The next morning, the primary care physician found a broken collar bone.”

Selected Action Steps

Page 8, III.A.3. Identify and promote utilization of high

quality, validated tools to assess and improve cultural

competency…

“Assessment is the first step to cultural competency.”

– Cyndi Treaster

Page 8, III.A.5. Promote the availability of cultural

competency resources (as stand-alone resources

and as resources integrated within other activities)

through multiple vehicles…

Examples

“Some medical facilities that have interpreters available have so few that we have waited 4-8 hours. At times, no one ever comes.”

“One 22-year-old was bilingual so the doctor let him translate for his parents. He died of his cancer the day after telling his parents yet again that the doctor said the treatment was working and he would get better. No one knew until the devastated parents told the interpreter. They don’t know if it was denial on his part or his inability to tell his parents the dreaded truth. Even at adult ages, the patient should not play both roles.”

Selected Action Steps

Page 8, III.B.3. Work with local universities, junior

colleges, high schools, and middle schools to

promote career opportunities in the health care field

among underrepresented groups….

“People will always be best served by professionals

from their own communities.” – workgroup member

“The more underrepresented groups in our health

care work force in the future, the more ‘heart’ it will

have to reach out to those on the margins.” – Sister

Janice Thome

Example

“I was paralyzed in 1977 when I was hit by a drunk driver…I spent 8 months in the hospital recovering from those injuries…. So one night I happened to be looking through my own medical chart while I was hanging out at the nurses station. There were notes from my social worker that said, ‘Patient is in denial of the severity of his injuries. He believes that he can still become a surgeon.’” – Peter A. Galpin, M.D., FACS, Plastic, Reconstructive, and Hand Surgeon (only surgeon in the United States to do all his medical and surgical training from a wheelchair)

For More Information:

Visit the Healthy Kansans 2010 website Disparities page: http://www.envisageconsulting.org/hk2010/Disparities.htm