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© 2010 Jones and Bartlett Publishers, LLC
Health Disparities: The Nebraska Perspective
Chapter 15
© 2010 Jones and Bartlett Publishers, LLC
Health Disparities: The Nebraska Perspective
Who are the “Cornhuskers?” Healthy People2010 : Increase quality of
healthy live and REDUCE health disparities Nebraska Healthy people 2010 Nebraska Office of Minority Health: 2003
Health Report and 2006 Strategic Plan Health Facts for racial/ethnic minorities web-
resources
© 2010 Jones and Bartlett Publishers, LLC
Health Disparities: The Nebraska Perspective Nebraska is cultural diverse: German, Irish,
English, Swedish and Czech. New input with Hispanic or Latinos, AA, NA, Asian American, Africans
This diversity produce varying colors, culture and languages
Growing Hispanics and Asian communities : 30% from 2000 to 2006
FAIR(2005) 92.187 foreign-born residents, 5.2% of all NE population
© 2010 Jones and Bartlett Publishers, LLC
Health Disparities: The Nebraska Perspective
Health Disparities in Nebraska Maternal and Child Health: 2000-4 Infant mortality
AA 2.9 times more than Whites NA 2.5 times more than Whites Latino Children are less likely to be immunized than
non Hispanic childrenLife expectancy and years of potential life lost: 2000-2 Life expectancy at birth for NA 67.9 years,
71.6 for AA and 78.3 for White non Hispanics
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Health Disparities: The Nebraska Perspective
Access to Care and Poverty : 2001-6 45.2% Hispanics adults with no insurance
36.8 % for NA 22.6% for AA 20.3% NA Adults unable to see a doctor in 12 mo 18.3% For Hispanics 15.6% for AA
© 2010 Jones and Bartlett Publishers, LLC
Health Disparities: The Nebraska Perspective Poverty level in Nebraska is 34% for AA and
26% for Latino 145.000 people under age of 65 are uninsured 27% total Latino population is uninsured NA have increase risk for Diabetes and
mortality due to hear disease AA highest rate of mortality for cancer 47.9% NA smoking and 20.5% Whites Latino population has increase prevalence in
asthma, COPD, HIV, obesity, suicide, teen pregnancy and TB
© 2010 Jones and Bartlett Publishers, LLC
Health Disparities: The Nebraska Perspective
What is Nebraska’s Commitment Today? What Are We Doing? Public Health Stakeholders in NE have urged
Health Disparities and Profession Associations to be aware of Cultural Competencies Increase Surveillance, surveillance of language needs,
quality of care, cultural barriers, best health practices In 2006 The office of Minority Health established the
medical translation and interpretation program
© 2010 Jones and Bartlett Publishers, LLC
Health Disparities: The Nebraska Perspective
State Financing for Nebraska Public Health 2001 : Nebraska legislature passed the Nebraska Health
Care Funding Act, Legislative Bill 692 47.5 million to found several public Health initiatives
Nebraska’s Office of Minority Health and Health Disparities Created in 1992 Health Department bureau and Health Policy and
planning
© 2010 Jones and Bartlett Publishers, LLC
Health Disparities: The Nebraska Perspective
Need for Public Health Leadership Leaders to reduce persistency of disparities Cultural competencies Economic-social cost Recruiting and retaining employees in the Health
Department WHO? Increase access to Health care with quality for
any race or minority group
© 2010 Jones and Bartlett Publishers, LLC
Health Disparities: The Nebraska Perspective
Health Education of Racial/Ethnic Minorities Bilingual guides Community Health workers Partnerships Health educators
© 2010 Jones and Bartlett Publishers, LLC
Health Disparities: The Nebraska Perspective
Obstacles Lack of cultural understanding Language barriers Poverty Limited resources Public policies Cultural differences Legal status Health education
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Health Disparities: The Nebraska Perspective
Who can help?
OMH (Offc of Minority Hlt) Focus groups multiple ideas Multiple opportunities Open mind
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Cultural Proficiency and Health Disparity:
The St. Louis, Missouri, Perspective
Chapter 16
© 2010 Jones and Bartlett Publishers, LLC
Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective
The Emergence and Growth of the City of St. Louis St Louis was the 8th largest City in US, now is the 50th, Health disparities Indicators like life expectancy, infant mortality, maternal
mortality, HIV, AIDS, STD : bad outcomes Multiple ethnicity:
Founded in 1764 1803 Trade Center 1847 Laws against education for Blacks 1875 High School education for Black children Currently still controversies about quality of education in minority
population
© 2010 Jones and Bartlett Publishers, LLC
Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective
Health Disparity in St. Louis: How Did It Happen?
The Genesis of Disparities AA are largest group in St. Louis. Poor health outcomes: lifestyle factors, AA identity theory
Multiples theories: Defective gene hypothesis Ghetto miasma hypothesis Social factors : income, education, occupation, family
status, coping with stress
© 2010 Jones and Bartlett Publishers, LLC
Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective
Financial Disparities
CEO $ 3.13 millions vs. Average worker
$37.900
© 2010 Jones and Bartlett Publishers, LLC
Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective
The question of Racism American theory : all men were created equal 1915-9 major interracial disturbances 1991 TV documentary with several disparities
seen. Association of racism with disparate health care outcomes
© 2010 Jones and Bartlett Publishers, LLC
Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective
Dred Scott
Emancipation Proclamation
Black H.S.
Riot WW II
Desegregation Race Documentary
1857 1863 1885 1917 1941 1952 1991
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Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective
Education and its role on healthcare disparities in St. Louis Public School Board : very little progress toward
excellence in education for all Poorly outcomes Poor leadership? Poor health literacy
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Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective
Cultural Proficiency in Clinical Medicine Cultural competency: success of outcome Cultural competency interview requires patience,
make pt comfortable, knowledge, attitude, skill to assure that their interpretation of circumstances and their beliefs system will be accepted and respected
© 2010 Jones and Bartlett Publishers, LLC
Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective
The St. Louis Perspective: How Can We Make It Better? Challenge how to educate professionals and provide them
with skills, attitude, and knowledge to provide culturally competent care
Medical Schools leadership, change of attitude needed and better understanding of health disparities
Current practitioners should strive to understand their own weaknesses of cultural proficiency
Increase admission of minorities in Medical Schools Capitalizing the presence of AHEC (area hlt ed ctr) Local medical societies take ownership of programs in
Health disparities to educate professionals
© 2010 Jones and Bartlett Publishers, LLC
Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective
© 2010 Jones and Bartlett Publishers, LLC
Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective
Summary Commitment from the City and the government Government as a Stakeholder Weekly teaching, programming, health education,
emergency preparedness, and dissemination of other important health information for the public
Need for resources Community has resources Multidisciplinary team effort
Federal Programs The Centers for Disease Control
and Prevention tries to address such
disparities through its REACH program,
short for Racial and Ethnic Approaches
to Community Health. The
program this year awarded grants to
40 organizations in 22 states.
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REACH REACH was established in 1999
and helps local programs decrease
disparities in six key health areas:
heart disease, diabetes, breast and
cervical cancer, immunizations,
infant mortality and HIV/AIDS.
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REACH It focuses on five racial and ethnic
groups: African-Americans, Hispanics/
Latinos, Asian-Americans,
Hawaiians/Pacific Islanders and
American Indians/Alaska Natives.
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REACH A competitive application process attracted
nearly 200 proposals and yielded
40 REACH grantees, which will be funded
for five years. California has the most
grantees with seven projects split between
Los Angeles and San Francisco. Massachusetts
and New York each have four.
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REACH Twenty-two of the grantees, including
the Community Health Councils in Los
Angeles, are funded as Action Communities
by the CDC to implement and evaluate
proven approaches targeted to specific
population groups. In addition to the six
key health areas previously mentioned,
REACH communities will also address
additional conditions contributing to
health disparities, including hepatitis B
and asthma.
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REACH The 18 other REACH grantees will
establish Centers of Excellence in the
Elimination of Health Disparities, which
are resource centers that will disseminate
information on practices that work and
train new communities to follow in the
footsteps of successful ones. These centers
draw on significant expertise with specific
ethnic populations.© 2010 Jones and Bartlett Publishers, LLC
Centers of Excellence for the Elimination ofHealth Disparities (CEED)
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Action Communities (AC)
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Successes A CDC survey found many previously funded
REACH community initiatives were successful in decreasing health disparities.
Among the survey results: The cholesterol screening rate for African-
Americans in REACH communities exceeded the national level in 2006, after being below the national average in 2002.
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Successes The cholesterol screening rate for Hispanics
in REACH communities continues to increase at a time when the rate for Hispanics across the U.S. is steadily decreasing.
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Successes The blood pressure screening rate for
American Indians from REACH communities in 2004 was higher than the rate for American Indians across the nation.
The rates of cigarette smoking among Asian men from REACH communities decreased from 42 percent in 2002 to 20 percent in 2006.
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