© 2010 Jones and Bartlett Publishers, LLC Health Disparities: The Nebraska Perspective Chapter 15.

© 2010 Jones and Bartlett Publishers, LLC

Health Disparities: The Nebraska Perspective

Chapter 15



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


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



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



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


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



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



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



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



Health Education of Racial/Ethnic Minorities Bilingual guides Community Health workers Partnerships Health educators



Obstacles Lack of cultural understanding Language barriers Poverty Limited resources Public policies Cultural differences Legal status Health education



Who can help?

OMH (Offc of Minority Hlt) Focus groups multiple ideas Multiple opportunities Open mind


Cultural Proficiency and Health Disparity:

The St. Louis, Missouri, Perspective

Chapter 16


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



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



Financial Disparities

CEO $ 3.13 millions vs. Average worker

$37.900



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



Dred Scott

Emancipation Proclamation

Black H.S.

Riot WW II

Desegregation Race Documentary

1857 1863 1885 1917 1941 1952 1991



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



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



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



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.


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.


REACH It focuses on five racial and ethnic

groups: African-Americans, Hispanics/

Latinos, Asian-Americans,

Hawaiians/Pacific Islanders and

American Indians/Alaska Natives.


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.


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.


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)


Action Communities (AC)


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.


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.


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.


© 2010 Jones and Bartlett Publishers, LLC Health Disparities: The Nebraska Perspective Chapter 15.

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Transcript of © 2010 Jones and Bartlett Publishers, LLC Health Disparities: The Nebraska Perspective Chapter 15.