Unnatural Causes: Stating the Problem and Finding Solutions Healthcare Equity :

Implications for Recreation Therapist

2011 Mid Eastern Symposium on

Therapeutic Recreation

Dr. Karen Bibbins Ed.D., CTRS

IntroductionsWhy is this topic important/interesting to you?

Objectives Increase your awareness of racial and ethnic

health disparities and the social determinants of health

Identify how achieving equity and addressing healthcare disparities can have implications for quality of care, risk management, accreditation and community benefits

Using best practices to address disparities when planning interventions for specific programs in RT

Health Care Equity…Is Inequality Making Us Sick

Ice Breaker – Perceptions Test Health Equity Quiz

Unnatural Causes

Groundbreaking 4 hour PBS documentary initially broadcast March 2008

Reframes the national debate over health as a medical detective story solving the mystery of health inequities

Deeper exploration into the ways social conditions affect health outcomes

Unnatural Causes- In Sickness & in Wealth

www.unnaturalcauses.org/video_clips.php

Unnatural Causes-Episode 1-

U.S. is one of the richest countries in the world, yet we rank 29th for life expectancy. We spent more than twice what other countries spend per capita on health care. Why aren’t we healthier?

Health disparity refers to… differences in health outcome or status

OR

differences in the preventive, diagnostic, and treatment services offered to people with similar health conditions

Definitions

Definitions

Healthcare disparity refers to… differences in the preventive, diagnostic, and

treatment services offered to people with similar health conditions

The social, cultural, religious, linguistic and other affiliations often characterized by cultural features such as dress, language, religion, and social organization

A term used to refer to groupings of people according to common origin or background and associated with perceived biological markers

Which definition is race and which ethnicity?

Definitions

race

ethnicity

Census categories

American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Some other race

The Story of Race

From the AAA Race Project The Story of Race

Activity

The Perfect Neighborhood www.unnaturalcauses.org/interactivities.php

Health Care Equity

Health disparities:Examining the numbers

Age-Adjusted Heart Disease Death Rates for Blacks and Whites, 1950-2000

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David Williams, PhD, MPH, Presentation to HFHS January 30, 2009

Hospital admissions for lower extremity amputations per 1,000 population age 18 and over with diabetes, by race, 2001-2003 and 2004-2006

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Discharge Survey and National Health Interview Survey, 2001-2003 and 2004-2006.

Emergency department (ED) visits in which patients left without being seen, by race (left) and payment source (right), 1997-1998, 1999-2000, 2001-2002, 2003-2004, and 2005-2006

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey, 1997-1998, 1999-2000, 2001-2002, 2003-2004, and 2005-2006.

Disparities: A National Problem

African Americans are referred less than whites for cardiac catheterization & bypass grafting

Latinos & African Americans receive less pain medication than whites for long bone fractures in the Emergency Department & for cancer pain on the floors

African Americans with end-stage renal disease are referred less to the transplant list than whites

Various healthcare disparities are present as well for certain Asian populations, American Indians and Alaska Natives, Arab Americans, and other communities of color

Evidence

Institute of Medicine, 2001

Proposed EQUITY as one of 6 aims for improvement

Evidence Institute of Medicine, 2003 Reported significant variation

in the rates of medical procedures by race, even when insurance status, income, age, and severity of conditions are comparable. This research indicates that U.S. racial and ethnic minorities are less likely to receive even routine medical procedures and experience a lower quality of health services.

Evidence

Three key themes emerge in the 2008 NHDR:

Racial and ethnic disparities persist in health care quality and access

The magnitude and pattern of disparities are different within subpopulations

Some disparities exist across multiple priority populations

Why do disparities in health exist? Social determinants of health

Socioeconomic status Stress Environment Racism

Lack of access to care Others

Why do disparities in healthcare exist? Health system factors

Complex health system may be poorly adapted to and difficult to navigate for minorities and those with limited English speaking proficiency

Care process variables Issues related to health providers such as stereotyping, impact of

race/ethnicity on decision making, and clinical uncertainly due to poor communication

Patient level variables Patient’s mistrust, poor adherence to treatment and delays in

seeking care

Implications for Recreation Therapist Increase awareness of health care equity Increase awareness of institutional barriers Understand and demonstrate ways to

eliminate health care disparities. Focus broadly on how health care disparities

affects all Americans Incorporate the role of personal responsibility

Best Practices

Leisure Ability Model Assessments Interventions

Closing & Reflections

Video It’s In Every One of Us Does anyone have any closing comments or

reflections to share with the group?

“Of all forms of inequality, injustice in healthcare is the most shocking and

inhumane.”

- Dr. Martin Luther King, Jr.

Closing & Reflections

Evaluation and Engagement

Please fill out the brief evaluation