Engendering health disparities.

Science.gov (United States)

Spitzer, Denise L

2005-01-01

How is gender implicated in our exploration of health disparities in Canada? Set against the backdrop of federal government policy, this review paper examines the ways in which gender intersects with other health determinants to produce disparate health outcomes. An overview of salient issues including the impact of gender roles, environmental exposures, gender violence, workplace hazards, economic disparities, the costs of poverty, social marginalization and racism, aging, health conditions, interactions with health services, and health behaviours are considered. This review suggests health is detrimentally affected by gender roles and statuses as they intersect with economic disparities, cultural, sexual, physical and historical marginalization as well as the strains of domestic and paid labour. These conditions result in an unfair health burden borne in particular by women whose access to health determinants is--in various degrees--limited. While progress has certainly been made on some fronts, the persistence of health disparities among diverse populations of women and men suggests a postponement of the vision of a just society with health for all that was articulated in the Federal Plan on Gender Equality. Commitment, creativity and collaboration from stakeholders ranging from various levels of government, communities, academics, non-governmental agencies and health professionals will be required to reduce and eliminate health disparities between and among all members of our society.

Socio-economic disparities in health system responsiveness in India.

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Malhotra, Chetna; Do, Young Kyung

2013-03-01

To assess the magnitude of socio-economic disparities in health system responsiveness in India after correcting for potential reporting heterogeneity by socio-economic characteristics (education and wealth). Data from Wave 1 of the Study on Global Ageing and Adult Health (2007-2008) involving six Indian states were used. Seven health system responsiveness domains were considered for a respondent's last visit to an outpatient service in 12 months: prompt attention, dignity, clarity of information, autonomy, confidentiality, choice and quality of basic amenities. Hierarchical ordered probit models (correcting for reporting heterogeneity through anchoring vignettes) were used to assess the association of socio-economic characteristics with the seven responsiveness domains, controlling for age, gender and area of residence. Stratified analysis was also conducted among users of public and private health facilities. Our statistical models accounting for reporting heterogeneity revealed socio-economic disparities in all health system responsiveness domains. Estimates suggested that individuals from the lowest wealth group, for example, were less likely than individuals from the highest wealth group to report 'very good' on the dignity domain by 8% points (10% vs 18%). Stratified analysis showed that such disparities existed among users of both public and private health facilities. Socio-economic disparities exist in health system responsiveness in India, irrespective of the type of health facility used. Policy efforts to monitor and improve these disparities are required at the health system level.

Approaching Environmental Health Disparities and Green Spaces: An Ecosystem Services Perspective

Directory of Open Access Journals (Sweden)

Viniece Jennings

2015-02-01

Full Text Available Health disparities occur when adverse health conditions are unequal across populations due in part to gaps in wealth. These disparities continue to plague global health. Decades of research suggests that the natural environment can play a key role in sustaining the health of the public. However, the influence of the natural environment on health disparities is not well-articulated. Green spaces provide ecosystem services that are vital to public health. This paper discusses the link between green spaces and some of the nation’s leading health issues such as obesity, cardiovascular health, heat-related illness, and psychological health. These associations are discussed in terms of key demographic variables—race, ethnicity, and income. The authors also identify research gaps and recommendations for future research.

Minority Health and Health Disparities

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... ik People" People Awakening Resilience Project (PARP), Cuqyun "Measuring" Treatment and Health Services Research Alcohol Treatment and ... addressing Health Disparities . 1 2009-2013 Health Disparities Strategic Plan, p.4 2 Ibid, p.4 3 ...

Socioeconomic disparities in health in the US: an agenda for action.

Science.gov (United States)

Moss, N

2000-12-01

Inequality of income and wealth in the US has been growing rapidly since 1972. Evidence of socioeconomic effects on health is documented for many endpoints, and there is evidence that socioeconomic disparities in health are increasing. In Europe, equity in health and health care is a target of the World Health Organization, and has led to a variety of activities to reduce socioeconomic disparities in morbidity and mortality. In the US, activities in the public and private sectors have increased in recent years but attention, especially among the public-at-large in addition to elites, needs to be shifted to socioeconomic disparities. The paper suggests action strategies drawn from the European experience and other US efforts to place public health priorities on the policy agenda. A first step is to create a climate of unacceptability for socioeconomic disparities in health. Recommended activities include improvement and utilization of existing data; dissemination to broad audiences; building on existing initiatives; creating multi-sectoral alliances; formation of state and community task forces; attention to human capital as well as social justice issues; creative use of media; attraction of new funders; and implementation of quantitative targets.

Identifying health disparities across the tobacco continuum.

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Fagan, Pebbles; Moolchan, Eric T; Lawrence, Deirdre; Fernander, Anita; Ponder, Paris K

2007-10-01

Few frameworks have addressed work-force diversity, inequities and inequalities as part of a comprehensive approach to eliminating tobacco-related health disparities. This paper summarizes the literature and describes the known disparities that exist along the tobacco disease continuum for minority racial and ethnic groups, those living in poverty, those with low education and blue-collar and service workers. The paper also discusses how work-force diversity, inequities in research practice and knowledge allocation and inequalities in access to and quality of health care are fundamental to addressing disparities in health. We examined the available scientific literature and existing public health reports to identify disparities across the tobacco disease continuum by minority racial/ethnic group, poverty status, education level and occupation. Results indicate that differences in risk indicators along the tobacco disease continuum do not explain fully tobacco-related cancer consequences among some minority racial/ethnic groups, particularly among the aggregate groups, blacks/African Americans and American Indians/Alaska Natives. The lack of within-race/ethnic group data and its interactions with socio-economic factors across the life-span contribute to the inconsistency we observe in the disease causal paradigm. More comprehensive models are needed to understand the relationships among disparities, social context, diversity, inequalities and inequities. A systematic approach will also help researchers, practitioners, advocates and policy makers determine critical points for interventions, the types of studies and programs needed and integrative approaches needed to eliminate tobacco-related disparities.

The moral problem of health disparities.

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Jones, Cynthia M

2010-04-01

Health disparities exist along lines of race/ethnicity and socioeconomic class in US society. I argue that we should work to eliminate these health disparities because their existence is a moral wrong that needs to be addressed. Health disparities are morally wrong because they exemplify historical injustices. Contractarian ethics, Kantian ethics, and utilitarian ethics all provide theoretical justification for viewing health disparities as a moral wrong, as do several ethical principles of primary importance in bioethics. The moral consequences of health disparities are also troubling and further support the claim that these disparities are a moral wrong. The Universal Declaration of Human Rights provides additional support that health disparities are a moral wrong, as does an analogy with the generally accepted duty to provide equal access to education. In this article, I also consider and respond to 3 objections to my thesis.

Challenges in covering health disparities in local news media: an exploratory analysis assessing views of journalists.

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Wallington, Sherrie Flynt; Blake, Kelly D; Taylor-Clark, Kalahn; Viswanath, K

2010-10-01

News coverage of health topics influences knowledge, attitudes, and behaviors at the individual level, and agendas and actions at the institutional and policy levels. Because disparities in health often are the result of social inequalities that require community-level or policy-level solutions, news stories employing a health disparities news frame may contribute to agenda-setting among opinion leaders and policymakers and lead to policy efforts aimed at reducing health disparities. This study objective was to conduct an exploratory analysis to qualitatively describe barriers that health journalists face when covering health disparities in local media. Between June and October 2007, 18 journalists from television, print, and radio in Boston, Lawrence, and Worcester, Massachusetts, were recruited using a purposive sampling technique. In-depth, semi-structured interviews were conducted by telephone, and the crystallization/immersion method was used to conduct a qualitative analysis of interview transcripts. Our results revealed that journalists said that they consider several angles when developing health stories, including public impact and personal behavior change. Challenges to employing a health disparities frame included inability to translate how research findings may impact different socioeconomic groups, and difficulty understanding how findings may translate across racial/ethnic groups. Several journalists reported that disparities-focused stories are "less palatable" for some audiences. This exploratory study offers insights into the challenges that local news media face in using health disparities news frames in their routine coverage of health news. Public health practitioners may use these findings to inform communication efforts with local media in order to advance the public dialogue about health disparities.

Health-related disparities: influence of environmental factors.

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Olden, Kenneth; White, Sandra L

2005-07-01

populations, but their frequency can vary substantially,rendering individuals or groups more or less susceptible to particular environmental exposures. Such findings are consistent with the highly publicized analogy, "genetics loads the gun, but the environment pulls the trigger." That is, one can inherit the genetic predisposition to develop a disease but will do so only if or when exposed to the environmental trigger. Poor people have approximately the same genetic makeup as everyone else,but they have the unfortunate experience of living and working in environments containing multiple and high levels of carcinogens or other toxicants capable of interacting with susceptibility genes to cause disease.Furthermore, certain disadvantaged ethnic groups may have a higher incidence of certain susceptible genes that render them more vulnerable to adverse effects of the environments they inhabit. For both of these reasons,much of the nation's disease burden could likely be reduced through better environmental protection practices, especially in low-income and minority communities. Of the many implications of polymorphisms and frequency variations for public health and the practice of medicine, however, none is more urgent than the choice of drugs in therapy. Using such knowledge,randomized trials have identified race-specific drug response differences between blacks and whites [42].To date, most knowledge of the health effects of environmental factors is derived from studies of single agents. The reality, though, is that environmental contributions to health disparities are mostly from multiple agents. These simultaneous exposures to multiple risk factors, which may accumulate or interact synergistically, remain to be fully explained and defined.Finally, health disparity is a significant public health problem that cannot be solved using "business as usual" approaches for funding and priority setting. The current emphasis on basic and clinical research at the exclusion of public

Health Psychology special series on health disparities

NARCIS (Netherlands)

Kazak, A.E.; Bosch, J.; Klonoff, E.A.

2012-01-01

With the initiation of this new ongoing special series in Health Psychology on health disparities, we will publish articles that highlight ways in which health psychology can contribute to understanding and ameliorating these disparities. We welcome articles for this new special series and

Clinical cultural competency and knowledge of health disparities among pharmacy students.

Science.gov (United States)

Okoro, Olihe N; Odedina, Folakemi T; Reams, Romonia R; Smith, W Thomas

2012-04-10

To evaluate the level of competency and knowledge about health disparities among third-year doctor of pharmacy (PharmD) students at 2 Florida public colleges of pharmacy and to explore the demographic correlates of these variables. A cross-sectional survey study design was used to collect data from participants. The students had low health-disparities knowledge and moderate skills in dealing with sociocultural issues and cross-cultural encounters. Speaking a language(s) other than English and having exposure to cultural-competency instruction were the demographic variables found to be most significantly associated with clinical cultural competency and/or knowledge of health disparities. Clinical cultural competency and health-disparities instruction may not be adequately incorporated into the pharmacy school curricula in the institutions studied. Relevant education and training are necessary to enhance cultural competency among pharmacy students.

Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care.

Science.gov (United States)

Betancourt, Joseph R; Green, Alexander R; Carrillo, J Emilio; Ananeh-Firempong, Owusu

2003-01-01

Racial/ethnic disparities in health in the U.S. have been well described. The field of "cultural competence" has emerged as one strategy to address these disparities. Based on a review of the relevant literature, the authors develop a definition of cultural competence, identify key components for intervention, and describe a practical framework for implementation of measures to address racial/ethnic disparities in health and health care. The authors conducted a literature review of academic, foundation, and government publications focusing on sociocultural barriers to care, the level of the health care system at which a given barrier occurs, and cultural competence efforts that address these barriers. Sociocultural barriers to care were identified at the organizational (leadership/workforce), structural (processes of care), and clinical (provider-patient encounter) levels. A framework of cultural competence interventions--including minority recruitment into the health professions, development of interpreter services and language-appropriate health educational materials, and provider education on cross-cultural issues--emerged to categorize strategies to address racial/ethnic disparities in health and health care. Demographic changes anticipated over the next decade magnify the importance of addressing racial/ethnic disparities in health and health care. A framework of organizational, structural, and clinical cultural competence interventions can facilitate the elimination of these disparities and improve care for all Americans.

Energy price disparity and public welfare

International Nuclear Information System (INIS)

Templet, P.H.

2001-01-01

The differences in the price of energy to economic sectors are linked to a number of system parameters and to public welfare. There are large disparities in energy prices within states when comparing residential and industrial prices although neoclassical economics predicts one price in markets. The large disparities between the two sectors across states negatively affects the efficiency of resource allocation, creates subsidies for those getting the cheap energy and results in unequal access to energy. These in turn lead to inefficient partitioning of energy between products and waste, higher pollution, leakage of wealth and poorer energy use efficiency, i.e. high energy intensity. States with large energy price disparities between sectors have statistically higher poverty, lower incomes, more pollution and use more energy but with less efficiency. Higher energy price disparities also result in higher throughput per unit of output thus reducing the chances for sustainability and lower public welfare. 31 refs

Effects of Social, Economic, and Labor Policies on Occupational Health Disparities

Science.gov (United States)

Siqueira, Carlos Eduardo; Gaydos, Megan; Monforton, Celeste; Slatin, Craig; Borkowski, Liz; Dooley, Peter; Liebman, Amy; Rosenberg, Erica; Shor, Glenn; Keifer, Matthew

2018-01-01

Background This article introduces some key labor, economic, and social policies that historically and currently impact occupational health disparities in the United States. Methods We conducted a broad review of the peer-reviewed and gray literature on the effects of social, economic, and labor policies on occupational health disparities. Results Many populations such as tipped workers, public employees, immigrant workers, and misclassified workers are not protected by current laws and policies, including worker’s compensation or Occupational Safety and Health Administration enforcement of standards. Local and state initiatives, such as living wage laws and community benefit agreements, as well as multiagency law enforcement contribute to reducing occupational health disparities. Conclusions There is a need to build coalitions and collaborations to command the resources necessary to identify, and then reduce and eliminate occupational disparities by establishing healthy, safe, and just work for all. PMID:23606055

Racial/ethnic disparities and culturally competent health care among youth and young men.

Science.gov (United States)

Vo, Dzung X; Park, M Jane

2008-06-01

Racial/ethnic disparities in health and health care are receiving increasing national attention from the fields of public health and medicine. Efforts to reduce disparities should adopt a life-span approach and recognize the role of gender. During adolescence, young people make increasingly independent decisions about health-related behavior and health care, while developing gender identity. Little is known about how cultural context shapes gender identity and gender identity's influence on health-related behavior and health care utilization. The authors review disparities in health status and health care among adolescents, especially young men, by reviewing health care access, clinical services, and issues related to culture, identity, and acculturation. Significant differences in health status by gender exist in adolescence, with young men faring worse on many health markers. This article discusses gaps in research and offers recommendations for improving health care quality and strengthening the research base on gender and disparities during adolescence.

Scalable Combinatorial Tools for Health Disparities Research

Directory of Open Access Journals (Sweden)

Michael A. Langston

2014-10-01

Full Text Available Despite staggering investments made in unraveling the human genome, current estimates suggest that as much as 90% of the variance in cancer and chronic diseases can be attributed to factors outside an individual’s genetic endowment, particularly to environmental exposures experienced across his or her life course. New analytical approaches are clearly required as investigators turn to complicated systems theory and ecological, place-based and life-history perspectives in order to understand more clearly the relationships between social determinants, environmental exposures and health disparities. While traditional data analysis techniques remain foundational to health disparities research, they are easily overwhelmed by the ever-increasing size and heterogeneity of available data needed to illuminate latent gene x environment interactions. This has prompted the adaptation and application of scalable combinatorial methods, many from genome science research, to the study of population health. Most of these powerful tools are algorithmically sophisticated, highly automated and mathematically abstract. Their utility motivates the main theme of this paper, which is to describe real applications of innovative transdisciplinary models and analyses in an effort to help move the research community closer toward identifying the causal mechanisms and associated environmental contexts underlying health disparities. The public health exposome is used as a contemporary focus for addressing the complex nature of this subject.

Health insurance coverage and racial disparities in breast reconstruction after mastectomy.

Science.gov (United States)

Shippee, Tetyana P; Kozhimannil, Katy B; Rowan, Kathleen; Virnig, Beth A

2014-01-01

Breast reconstruction after mastectomy offers clinical, cosmetic, and psychological benefits compared with mastectomy alone. Although reconstruction rates have increased, racial/ethnic disparities in breast reconstruction persist. Insurance coverage facilitates access to care, but few studies have examined whether health insurance ameliorates disparities. We used the Nationwide Inpatient Sample for 2002 through 2006 to examine the relationships between health insurance coverage, race/ethnicity, and breast reconstruction rates among women who underwent mastectomy for breast cancer. We examined reconstruction rates as a function of the interaction of race and the primary payer (self-pay, private health insurance, government) while controlling for patient comorbidity, and we used generalized estimating equations to account for clustering and hospital characteristics. Minority women had lower breast reconstruction rates than White women (adjusted odds ratio [AOR], 0.57 for African American; AOR, 0.70 for Hispanic; AOR, 0.45 for Asian; p women (AOR, 0.33) and those with public coverage were less likely to undergo reconstruction (AOR, 0.35; p women. Racial/ethnic disparities were less prominent within insurance types. Minority women, whether privately or publicly insured, had lower odds of undergoing reconstruction than White women. Among those without insurance, reconstruction rates did not differ by race/ethnicity. Insurance facilitates access to care, but does not eliminate racial/ethnic disparities in reconstruction rates. Our findings-which reveal persistent health care disparities not explained by patient health status-should prompt efforts to promote both access to and use of beneficial covered services for women with breast cancer. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Disseminating Health Disparities Education Through Tele-Learning

Directory of Open Access Journals (Sweden)

LaSonya Knowles

2008-08-01

Full Text Available Twenty years of research demonstrate that there are wide disparities in health throughout America. Health disparities are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist when specific population subgroups are compared. Health Disparities in America: Working Toward Social Justice is a course instructed every fall by Dr. Lovell Jones, director of The Center for Research on Minority Health (CRMH at UT M.D. Anderson Cancer Center. The CRMH has created a course that examines the social and societal factors that are fundamental in creating disparities in health. Students from 10 different academic programs and institutions participate in this course. The course is unique in the aspect that various, diverse speakers whom are experts in their field of study instruct each class. This health disparities course is conducted at one of three different academic institutions in the Houston area and broadcast via satellite to various academic institutions by means of teleeducation. Tele-education is defined as a mode of instruction utilizing different forms of media such as video, audio technology tools and computers. Video and audio technologies involve the transmission of interface between learners and instructors, either interactive or non-interactive. Tele-education technologies have an important role to play in addressing the dissemination of health disparities education. The purpose of this program is to determine the feasibility of tele-education as a mode of instruction to introduce the multi-disciplinary components of health disparities. Our findings suggest that tele-education is a useful tool in imparting health disparities education.

Addressing health and health-care disparities: the role of a diverse workforce and the social determinants of health.

Science.gov (United States)

Jackson, Chazeman S; Gracia, J Nadine

2014-01-01

Despite major advances in medicine and public health during the past few decades, disparities in health and health care persist. Racial/ethnic minority groups in the United States are at disproportionate risk of being uninsured, lacking access to care, and experiencing worse health outcomes from preventable and treatable conditions. As reducing these disparities has become a national priority, insight into the social determinants of health has become increasingly important. This article offers a rationale for increasing the diversity and cultural competency of the health and health-care workforce, and describes key strategies led by the U.S. Department of Health and Human Services' Office of Minority Health to promote cultural competency in the health-care system and strengthen community-level approaches to improving health and health care for all.

The next public health revolution: public health information fusion and social networks.

Science.gov (United States)

Khan, Ali S; Fleischauer, Aaron; Casani, Julie; Groseclose, Samuel L

2010-07-01

Social, political, and economic disruptions caused by natural and human-caused public health emergencies have catalyzed public health efforts to expand the scope of biosurveillance and increase the timeliness, quality, and comprehensiveness of disease detection, alerting, response, and prediction. Unfortunately, efforts to acquire, render, and visualize the diversity of health intelligence information are hindered by its wide distribution across disparate fields, multiple levels of government, and the complex interagency environment. Achieving this new level of situation awareness within public health will require a fundamental cultural shift in methods of acquiring, analyzing, and disseminating information. The notion of information "fusion" may provide opportunities to expand data access, analysis, and information exchange to better inform public health action.

Disparities in lifestyle habits and health related factors of Montreal immigrants: is immigration an important exposure variable in public health?

Science.gov (United States)

Meshefedjian, Garbis A; Leaune, Viviane; Simoneau, Marie-Ève; Drouin, Mylène

2014-10-01

Study disparities in lifestyle habits and health characteristics of Canadian born population and immigrants with different duration of residence. Data are extracted from 2009 to 2010 public use micro-data files of Canadian Community Health Survey representing about 1.5 million people. Sixty-one percent of the study sample was born in Canada; 49 % males and 59 % below age 50. Amongst lifestyle habits, recent immigrants were less likely to be regular smokers, RR (95 % CI) 0.56 (0.36-0.88) and frequent consumers of alcohol 0.49 (0.27-0.89), but more likely to consume less fruits and vegetables 1.26 (1.04-1.53) than those born in Canada. Amongst health related factors, recent immigrants were less likely to be overweight 0.79 (0.62-0.99) and suffer from chronic diseases 0.59 (0.44-0.80), but more likely to have limited access to family medicine 1.24 (1.04-1.47) than Canada-born population. Immigration status is an important population characteristic which influenced distribution of health indicators. Prevention and promotion strategies should consider immigration status as an exposure variable in the development and implementation of public health programs.

Environmental Health Disparities in Housing

Science.gov (United States)

2011-01-01

The physical infrastructure and housing make human interaction possible and provide shelter. How well that infrastructure performs and which groups it serves have important implications for social equity and health. Populations in inadequate housing are more likely to have environmental diseases and injuries. Substantial disparities in housing have remained largely unchanged. Approximately 2.6 million (7.5%) non-Hispanic Blacks and 5.9 million Whites (2.8%) live in substandard housing. Segregation, lack of housing mobility, and homelessness are all associated with adverse health outcomes. Yet the experience with childhood lead poisoning in the United States has shown that housing-related disparities can be reduced. Effective interventions should be implemented to reduce environmental health disparities related to housing. PMID:21551378

Global health disparities: crisis in the diaspora.

Science.gov (United States)

Cox, Raymond L.

2004-01-01

The United States spends more than the rest of the world on healthcare. In 2000, the U.S. health bill was 1.3 trillion dollars, 14.5% of its gross domestic product. Yet, according to the WHO World Health Report 2000, the United States ranked 37th of 191 member nations in overall health system performance. Racial/ethnic disparities in health outcomes are the most obvious examples of an unbalanced healthcare system. This presentation will examine health disparities in the United States and reveal how health disparities among and within countries affect the health and well-being of the African Diaspora. PMID:15101675

Literacy and Health Disparities

Science.gov (United States)

Prins, Esther; Mooney, Angela

2014-01-01

This chapter explores the relationship between literacy and health disparities, focusing on the concept of health literacy. Recommendations are provided for ways to bridge the health literacy gap for learners in adult basic education and family literacy programs.

Globalisation and global health governance: implications for public health.

Science.gov (United States)

Kruk, Margaret E

2012-01-01

Globalisation is a defining economic and social trend of the past several decades. Globalisation affects health directly and indirectly and creates economic and health disparities within and across countries. The political response to address these disparities, exemplified by the Millennium Development Goals, has put pressure on the global community to redress massive inequities in health and other determinants of human capability across countries. This, in turn, has accelerated a transformation in the architecture of global health governance. The entrance of new actors, such as private foundations and multi-stakeholder initiatives, contributed to a doubling of funds for global health between 2000 and 2010. Today the governance of public health is in flux, with diminished leadership from multilateral institutions, such as the WHO, and poor coherence in policy and programming that undermines the potential for sustainable health gains. These trends pose new challenges and opportunities for global public health, which is centrally concerned with identifying and addressing threats to the health of vulnerable populations worldwide.

78 FR 35837 - National Institute on Minority Health and Health Disparities Research Endowments

Science.gov (United States)

2013-06-14

... disparities research to close the disparity gap in the burden of illness and death experienced by racial and... Number NIH-2007-0931] RIN 0925-AA61 National Institute on Minority Health and Health Disparities Research... disparities research and other health disparities research. DATES: Comments must be received on or before...

Health Disparities Calculator (HD*Calc) - SEER Software

Science.gov (United States)

Statistical software that generates summary measures to evaluate and monitor health disparities. Users can import SEER data or other population-based health data to calculate 11 disparity measurements.

Big Data Science: Opportunities and Challenges to Address Minority Health and Health Disparities in the 21st Century

Science.gov (United States)

Zhang, Xinzhi; Pérez-Stable, Eliseo J.; Bourne, Philip E.; Peprah, Emmanuel; Duru, O. Kenrik; Breen, Nancy; Berrigan, David; Wood, Fred; Jackson, James S.; Wong, David W.S.; Denny, Joshua

2017-01-01

Addressing minority health and health disparities has been a missing piece of the puzzle in Big Data science. This article focuses on three priority opportunities that Big Data science may offer to the reduction of health and health care disparities. One opportunity is to incorporate standardized information on demographic and social determinants in electronic health records in order to target ways to improve quality of care for the most disadvantaged populations over time. A second opportunity is to enhance public health surveillance by linking geographical variables and social determinants of health for geographically defined populations to clinical data and health outcomes. Third and most importantly, Big Data science may lead to a better understanding of the etiology of health disparities and understanding of minority health in order to guide intervention development. However, the promise of Big Data needs to be considered in light of significant challenges that threaten to widen health disparities. Care must be taken to incorporate diverse populations to realize the potential benefits. Specific recommendations include investing in data collection on small sample populations, building a diverse workforce pipeline for data science, actively seeking to reduce digital divides, developing novel ways to assure digital data privacy for small populations, and promoting widespread data sharing to benefit under-resourced minority-serving institutions and minority researchers. With deliberate efforts, Big Data presents a dramatic opportunity for reducing health disparities but without active engagement, it risks further widening them. PMID:28439179

Big Data Science: Opportunities and Challenges to Address Minority Health and Health Disparities in the 21st Century.

Science.gov (United States)

Zhang, Xinzhi; Pérez-Stable, Eliseo J; Bourne, Philip E; Peprah, Emmanuel; Duru, O Kenrik; Breen, Nancy; Berrigan, David; Wood, Fred; Jackson, James S; Wong, David W S; Denny, Joshua

2017-01-01

Addressing minority health and health disparities has been a missing piece of the puzzle in Big Data science. This article focuses on three priority opportunities that Big Data science may offer to the reduction of health and health care disparities. One opportunity is to incorporate standardized information on demographic and social determinants in electronic health records in order to target ways to improve quality of care for the most disadvantaged populations over time. A second opportunity is to enhance public health surveillance by linking geographical variables and social determinants of health for geographically defined populations to clinical data and health outcomes. Third and most importantly, Big Data science may lead to a better understanding of the etiology of health disparities and understanding of minority health in order to guide intervention development. However, the promise of Big Data needs to be considered in light of significant challenges that threaten to widen health disparities. Care must be taken to incorporate diverse populations to realize the potential benefits. Specific recommendations include investing in data collection on small sample populations, building a diverse workforce pipeline for data science, actively seeking to reduce digital divides, developing novel ways to assure digital data privacy for small populations, and promoting widespread data sharing to benefit under-resourced minority-serving institutions and minority researchers. With deliberate efforts, Big Data presents a dramatic opportunity for reducing health disparities but without active engagement, it risks further widening them.

Health Disparities in Veterans: A Map of the Evidence.

Science.gov (United States)

Kondo, Karli; Low, Allison; Everson, Teresa; Gordon, Christine D; Veazie, Stephanie; Lozier, Crystal C; Freeman, Michele; Motu'apuaka, Makalapua; Mendelson, Aaron; Friesen, Mark; Paynter, Robin; Friesen, Caroline; Anderson, Johanna; Boundy, Erin; Saha, Somnath; Quiñones, Ana; Kansagara, Devan

2017-09-01

Goals for improving the quality of care for all Veterans and eliminating health disparities are outlined in the Veterans Health Administration Blueprint for Excellence, but the degree to which disparities in utilization, health outcomes, and quality of care affect Veterans is not well understood. To characterize the research on health care disparities in the Veterans Health Administration by means of a map of the evidence. We conducted a systematic search for research studies published from 2006 to February 2016 in MEDLINE and other data sources. We included studies of Veteran populations that examined disparities in 3 outcome categories: utilization, quality of health care, and patient health. We abstracted data on study design, setting, population, clinical area, outcomes, mediators, and presence of disparity for each outcome category. We grouped the data by population characteristics including race, disability status, mental illness, demographics (age, era of service, rural location, and distance from care), sex identity, socioeconomic status, and homelessness, and created maps illustrating the evidence. We reviewed 4249 citations and abstracted data from 351 studies which met inclusion criteria. Studies examining disparities by race/ethnicity comprised by far the vast majority of the literature, followed by studies examining disparities by sex, and mental health condition. Very few studies examined disparities related to lesbian, gay, bisexual, or transgender identity or homelessness. Disparities findings vary widely by population and outcome. Our evidence maps provide a "lay of the land" and identify important gaps in knowledge about health disparities experienced by different Veteran populations.

Do wealth disparities contribute to health disparities within racial/ethnic groups?

Science.gov (United States)

Pollack, Craig Evan; Cubbin, Catherine; Sania, Ayesha; Hayward, Mark; Vallone, Donna; Flaherty, Brian; Braveman, Paula A

2013-05-01

Though wide disparities in wealth have been documented across racial/ethnic groups, it is largely unknown whether differences in wealth are associated with health disparities within racial/ethnic groups. Data from the Survey of Consumer Finances (2004, ages 25-64) and the Health and Retirement Survey (2004, ages 50+), containing a wide range of assets and debts variables, were used to calculate net worth (a standard measure of wealth). Among non-Hispanic black, Hispanic and non-Hispanic white populations, we tested whether wealth was associated with self-reported poor/fair health status after accounting for income and education. Except among the younger Hispanic population, net worth was significantly associated with poor/fair health status within each racial/ethnic group in both data sets. Adding net worth attenuated the association between education and poor/fair health (in all racial/ethnic groups) and between income and poor/fair health (except among older Hispanics). The results add to the literature indicating the importance of including measures of wealth in health research for what they may reveal about disparities not only between but also within different racial/ethnic groups.

Rural Health Disparities

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... in the Delta Region for specific data. U.S. – Mexico Border While life expectancy in many counties of ... documents the successes, challenges, and relevant information for planning. ... on rural/urban disparities see What sources cover health behaviors and ...

75 FR 66114 - National Center on Minority Health and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2010-10-27

... Health and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; NCMHD Health Disparities Research on Minority and... Review Officer, National Institute on Minority Health and Health Disparities, 6707 Democracy Boulevard...

75 FR 12766 - National Center on Minority Health and Health Disparities; Notice of Closed Meetings

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2010-03-17

... Health and Health Disparities; Notice of Closed Meetings Pursuant to section 10(d) of the Federal... and Health Disparities Special Emphasis Panel Loan Repayment Program for Health Disparities Research... Review, National Center on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800...

75 FR 9421 - National Center on Minority Health and Health Disparities; Notice of Closed Meeting

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2010-03-02

... Health and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; Loan Repayment Program for Health Disparities Research..., National Center on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda...

Paradigm shifts in disability and health: toward more ethical public health research.

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McDonald, Katherine E; Raymaker, Dora M

2013-12-01

Disability is often considered a health outcome disproportionately experienced by minority groups. It is also possible to view people with disabilities as a minority group that itself experiences health disparities. Calls to reduce these disparities necessitate the inclusion of people with developmental disabilities in research, although resulting ethical issues can thwart scientific progress. Using disability rights principles can help address ethical challenges and promote safe, respectful public health research. Examples include applying human rights frameworks, providing accommodations, attending to power, countering legacies of deficits-based models of disability, and transforming access to science more broadly. Collectively, these strategies can encourage broader engagement in safe, respectful, inclusive public health research aimed at promoting the health and well-being of people with developmental disabilities.

Epidemiology, Policy, and Racial/Ethnic Minority Health Disparities

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Carter-Pokras, Olivia; Offutt-Powell, Tabatha; Kaufman, Jay S.; Giles, Wayne; Mays, Vickie

2013-01-01

Purpose Epidemiologists have long contributed to policy efforts to address health disparities. Three examples illustrate how epidemiologists have addressed health disparities in the U.S. and abroad through a “social determinants of health” lens. Methods To identify examples of how epidemiologic research has been applied to reduce health disparities, we queried epidemiologists engaged in disparities research in the U.S., Canada, and New Zealand, and drew upon the scientific literature. Results Resulting examples covered a wide range of topic areas. Three areas selected for their contributions to policy were: 1) epidemiology's role in definition and measurement, 2) the study of housing and asthma, and 3) the study of food policy strategies to reduce health disparities. While epidemiologic research has done much to define and quantify health inequalities, it has generally been less successful at producing evidence that would identify targets for health equity intervention. Epidemiologists have a role to play in measurement and basic surveillance, etiologic research, intervention research, and evaluation research. However, our training and funding sources generally place greatest emphasis on surveillance and etiologic research. Conclusions: The complexity of health disparities requires better training for epidemiologists to effectively work in multidisciplinary teams. Together we can evaluate contextual and multilevel contributions to disease and study intervention programs in order to gain better insights into evidenced-based health equity strategies. PMID:22626003

Understanding health literacy for strategic health marketing: eHealth literacy, health disparities, and the digital divide.

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Bodie, Graham D; Dutta, Mohan Jyoti

2008-01-01

Even despite policy efforts aimed at reducing health-related disparities, evidence mounts that population-level gaps in literacy and healthcare quality are increasing. This widening of disparities in American culture is likely to worsen over the coming years due, in part, to our increasing reliance on Internet-based technologies to disseminate health information and services. The purpose of the current article is to incorporate health literacy into an Integrative Model of eHealth Use. We argue for this theoretical understanding of eHealth literacy and propose that macro-level disparities in social structures are connected to health disparities through the micro-level conduits of eHealth literacy, motivation, and ability. In other words, structural inequities reinforce themselves and continue to contribute to healthcare disparities through the differential distribution of technologies that simultaneously enhance and impede literacy, motivation, and ability of different groups (and individuals) in the population. We conclude the article by suggesting pragmatic implications of our analysis.

The role of health-related behaviors in the socioeconomic disparities in oral health.

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Sabbah, Wael; Tsakos, Georgios; Sheiham, Aubrey; Watt, Richard G

2009-01-01

This study aimed to examine the socioeconomic disparities in health-related behaviors and to assess if behaviors eliminate socioeconomic disparities in oral health in a nationally representative sample of adult Americans. Data are from the US Third National Health and Nutrition Examination Survey (1988-1994). Behaviors were indicated by smoking, dental visits, frequency of eating fresh fruits and vegetables and extent of calculus, used as a marker for oral hygiene. Oral health outcomes were gingival bleeding, loss of periodontal attachment, tooth loss and perceived oral health. Education and income indicated socioeconomic position. Sex, age, ethnicity, dental insurance and diabetes were adjusted for in the regression analysis. Regression analysis was used to assess socioeconomic disparities in behaviors. Regression models adjusting and not adjusting for behaviors were compared to assess the change in socioeconomic disparities in oral health. The results showed clear socioeconomic disparities in all behaviors. After adjusting for behaviors, the association between oral health and socioeconomic indicators attenuated but did not disappear. These findings imply that improvement in health-related behaviors may lessen, but not eliminate socioeconomic disparities in oral health, and suggest the presence of more complex determinants of these disparities which should be addressed by oral health preventive policies.

Determinants of health disparities between Italian regions

Directory of Open Access Journals (Sweden)

Giannoni Margherita

2010-06-01

Full Text Available Abstract Background Among European countries, Italy is one of the countries where regional health disparities contribute substantially to socioeconomic health disparities. In this paper, we report on regional differences in self-reported poor health and explore possible determinants at the individual and regional levels in Italy. Methods We use data from the "Indagine Multiscopo sulle Famiglie", a survey of aspects of everyday life in the Italian population, to estimate multilevel logistic regressions that model poor self-reported health as a function of individual and regional socioeconomic factors. Next we use the causal step approach to test if living conditions, healthcare characteristics, social isolation, and health behaviors at the regional level mediate the relationship between regional socioeconomic factors and self-rated health. Results We find that residents living in regions with more poverty, more unemployment, and more income inequality are more likely to report poor health and that poor living conditions and private share of healthcare expenditures at the regional level mediate socioeconomic disparities in self-rated health among Italian regions. Conclusion The implications are that regional contexts matter and that regional policies in Italy have the potential to reduce health disparities by implementing interventions aimed at improving living conditions and access to quality healthcare.

Challenges for Multilevel Health Disparities Research in a Transdisciplinary Environment

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Holmes, John H.; Lehman, Amy; Hade, Erinn; Ferketich, Amy K.; Sarah, Gehlert; Rauscher, Garth H.; Abrams, Judith; Bird, Chloe E.

2008-01-01

Numerous factors play a part in health disparities. Although health disparities are manifested at the level of the individual, other contexts should be considered when investigating the associations of disparities with clinical outcomes. These contexts include families, neighborhoods, social organizations, and healthcare facilities. This paper reports on health disparities research as a multilevel research domain from the perspective of a large national initiative. The Centers for Population Health and Health Disparities (CPHHD) program was established by the NIH to examine the highly dimensional, complex nature of disparities and their effects on health. Because of its inherently transdisciplinary nature, the CPHHD program provides a unique environment in which to perform multilevel health disparities research. During the course of the program, the CPHHD centers have experienced challenges specific to this type of research. The challenges were categorized along three axes: sources of subjects and data, data characteristics, and multilevel analysis and interpretation. The CPHHDs collectively offer a unique example of how these challenges are met; just as importantly, they reveal a broad range of issues that health disparities researchers should consider as they pursue transdisciplinary investigations in this domain, particularly in the context of a large team science initiative. PMID:18619398

Gender disparities in health care.

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Kent, Jennifer A; Patel, Vinisha; Varela, Natalie A

2012-01-01

The existence of disparities in delivery of health care has been the subject of increased empirical study in recent years. Some studies have suggested that disparities between men and women exist in the diagnoses and treatment of health conditions, and as a result measures have been taken to identify these differences. This article uses several examples to illustrate health care gender bias in medicine. These examples include surgery, peripheral artery disease, cardiovascular disease, critical care, and cardiovascular risk factors. Additionally, we discuss reasons why these issues still occur, trends in health care that may address these issues, and the need for acknowledgement of the current system's inequities in order to provide unbiased care for women in the future. © 2012 Mount Sinai School of Medicine.

CDC Health Disparities and Inequalities Report--U.S. 2013

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... Women's Health Health Literacy Health Equity CDC Health Disparities & Inequalities Report (CHDIR) Recommend on Facebook Tweet Share ... 2011 Report More Information CDC Releases Second Health Disparities & Inequalities Report - United States, 2013 CDC and its ...

Integrating intersectionality and biomedicine in health disparities research.

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Kelly, Ursula A

2009-01-01

Persisting health disparities have lead to calls for an increase in health research to address them. Biomedical scientists call for research that stratifies individual indicators associated with health disparities, for example, ethnicity. Feminist social scientists recommend feminist intersectionality research. Intersectionality is the multiplicative effect of inequalities experienced by nondominant marginalized groups, for example, ethnic minorities, women, and the poor. The elimination of health disparities necessitates integration of both paradigms in health research. This study provides a practical application of the integration of biomedical and feminist intersectionality paradigms in nursing research, using a psychiatric intervention study with battered Latino women as an example.

A school-based public health model to reduce oral health disparities.

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Dudovitz, Rebecca N; Valiente, Jonathan E; Espinosa, Gloria; Yepes, Claudia; Padilla, Cesar; Puffer, Maryjane; Slavkin, Harold C; Chung, Paul J

2018-12-01

Although dental decay is preventable, it remains the most common pediatric chronic disease. We describe a public health approach to implementing a scalable and sustainable school-based oral health program for low-income urban children. The Los Angeles Trust for Children's Health, a nonprofit affiliated with the Los Angeles Unified School District, applied a public health model and developed a broad-based community-coalition to a) establish a District Oral Health Nurse position to coordinate oral health services, and b) implement a universal school-based oral health screening and fluoride varnishing program, with referral to a dental home. Key informant interviews and focus groups informed program development. Parent surveys assessed preventative oral health behaviors and access to oral health services. Results from screening exams, program costs and rates of reimbursement were recorded. From 2012 to 2015, six elementary schools and three dental provider groups participated. Four hundred ninety-one parents received oral health education and 89 served as community oral health volunteers; 3,399 screenings and fluoride applications were performed on 2,776 children. Sixty-six percent of children had active dental disease, 27 percent had visible tooth decay, and 6 percent required emergent care. Of the 623 students who participated for two consecutive years, 56 percent had fewer or no visible caries at follow-up, while only 17 percent had additional disease. Annual program cost was $69.57 per child. Using a broad based, oral health coalition, a school-based universal screening and fluoride varnishing program can improve the oral health of children with a high burden of untreated dental diseases. © 2017 American Association of Public Health Dentistry.

Choropleth map legend design for visualizing community health disparities

Directory of Open Access Journals (Sweden)

Cromley Ellen K

2009-09-01

Full Text Available Abstract Background Disparities in health outcomes across communities are a central concern in public health and epidemiology. Health disparities research often links differences in health outcomes to other social factors like income. Choropleth maps of health outcome rates show the geographical distribution of health outcomes. This paper illustrates the use of cumulative frequency map legends for visualizing how the health events are distributed in relation to social characteristics of community populations. The approach uses two graphs in the cumulative frequency legend to highlight the difference between the raw count of the health events and the raw count of the social characteristic like low income in the geographical areas of the map. The approach is applied to mapping publicly available data on low birth weight by town in Connecticut and Lyme disease incidence by town in Connecticut in relation to income. The steps involved in creating these legends are described in detail so that health analysts can adopt this approach. Results The different health problems, low birth weight and Lyme disease, have different cumulative frequency signatures. Graphing poverty population on the cumulative frequency legends revealed that the poverty population is distributed differently with respect to the two different health problems mapped here. Conclusion Cumulative frequency legends can be useful supplements for choropleth maps. These legends can be constructed using readily available software. They contain all of the information found in standard choropleth map legends, and they can be used with any choropleth map classification scheme. Cumulative frequency legends effectively communicate the proportion of areas, the proportion of health events, and/or the proportion of the denominator population in which the health events occurred that falls within each class interval. They illuminate the context of disease through graphing associations with other

Promoting Community Health and Eliminating Health Disparities Through Community-Based Participatory Research.

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Xia, Ruiping; Stone, John R; Hoffman, Julie E; Klappa, Susan G

2016-03-01

In physical therapy, there is increasing focus on the need at the community level to promote health, eliminate disparities in health status, and ameliorate risk factors among underserved minorities. Community-based participatory research (CBPR) is the most promising paradigm for pursuing these goals. Community-based participatory research stresses equitable partnering of the community and investigators in light of local social, structural, and cultural elements. Throughout the research process, the CBPR model emphasizes coalition and team building that joins partners with diverse skills/expertise, knowledge, and sensitivities. This article presents core concepts and principles of CBPR and the rationale for its application in the management of health issues at the community level. Community-based participatory research is now commonly used to address public health issues. A literature review identified limited reports of its use in physical therapy research and services. A published study is used to illustrate features of CBPR for physical therapy. The purpose of this article is to promote an understanding of how physical therapists could use CBPR as a promising way to advance the profession's goals of community health and elimination of health care disparities, and social responsibility. Funding opportunities for the support of CBPR are noted. © 2016 American Physical Therapy Association.

Conceptualising paediatric health disparities: a metanarrative systematic review and unified conceptual framework.

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Ridgeway, Jennifer L; Wang, Zhen; Finney Rutten, Lila J; van Ryn, Michelle; Griffin, Joan M; Murad, M Hassan; Asiedu, Gladys B; Egginton, Jason S; Beebe, Timothy J

2017-08-04

There exists a paucity of work in the development and testing of theoretical models specific to childhood health disparities even though they have been linked to the prevalence of adult health disparities including high rates of chronic disease. We conducted a systematic review and thematic analysis of existing models of health disparities specific to children to inform development of a unified conceptual framework. We systematically reviewed articles reporting theoretical or explanatory models of disparities on a range of outcomes related to child health. We searched Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus (database inception to 9 July 2015). A metanarrative approach guided the analysis process. A total of 48 studies presenting 48 models were included. This systematic review found multiple models but no consensus on one approach. However, we did discover a fair amount of overlap, such that the 48 models reviewed converged into the unified conceptual framework. The majority of models included factors in three domains: individual characteristics and behaviours (88%), healthcare providers and systems (63%), and environment/community (56%), . Only 38% of models included factors in the health and public policies domain. A disease-agnostic unified conceptual framework may inform integration of existing knowledge of child health disparities and guide future research. This multilevel framework can focus attention among clinical, basic and social science research on the relationships between policy, social factors, health systems and the physical environment that impact children's health outcomes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Sexual and Gender Minority Health Curricula and Institutional Support Services at U.S. Schools of Public Health.

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Talan, Ali J; Drake, Carolyn B; Glick, Jennifer L; Claiborn, Camilla Scott; Seal, David

2017-01-01

Limited research has examined the ways in which public health training programs equip students to address health disparities affecting the lesbian, gay, bisexual, and transgender (LGBT) community and other sexual and gender minority (SGM) populations. This study outlines the availability of public health curricula on SGM health topics, and the prevalence of LGBT and SGM-inclusive institutional support services across CEPH-accredited U.S. schools of public health. Content analysis of all course offerings related to gender and sexuality revealed a limited focus on sexual and gender minority health: just 4.7% of courses contained keywords indicating that LGBT or SGM health topics were covered. Similar analysis of institutional support services available at U.S. schools of public health found that only 25% of schools had LGBT student organizations, and just 19% had an office of diversity that specifically advertised LGBT or SGM-inclusive programming or services on the institution's Web site. Finally, only two of 52 schools offered an educational certificate centered on LGBT health. These findings illustrate a significant need for enhanced curricular content and institutional support services that equip public health students to address SGM health disparities. Improvement in this area may encourage future health care professionals to work to reduce these disparities, to improve SGM persons' experiences in health care settings, and to generate further research in this area.

77 FR 36564 - National Institute on Minority Health and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2012-06-19

... Minority Health and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal... and Health Disparities Special Emphasis Panel; NIMHD Support for Conference and Scientific meetings... Institutes of Health, National Institute on Minority Health and Health Disparities, 6707 Democracy Blvd...

Examples of Cancer Health Disparities

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... and the bacterium H. pylori (stomach cancer) in immigrant countries of origin contributes to these disparities. ( ACS ) ... Cancer.gov en español Multimedia Publications Site Map Digital Standards for NCI Websites POLICIES Accessibility Comment Policy ...

Racial/Ethnic Disparities in Mental Health Care Utilization among U.S. College Students: Applying the Institution of Medicine Definition of Health Care Disparities.

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Hunt, Justin B; Eisenberg, Daniel; Lu, Liya; Gathright, Molly

2015-10-01

The authors apply the Institute of Medicine's definition of health care disparities to college students. The analysis pools data from the first two waves of the Healthy Minds Study, a multicampus survey of students' mental health (N = 13,028). A probit model was used for any past-year service utilization, and group differences in health status were adjusted by transforming the entire distribution for each minority population to approximate the white distribution. Disparities existed between whites and all minority groups. Compared to other approaches, the predicted service disparities were greater because this method included the effects of mediating SES variables. Health care disparities persist in the college setting despite improved access and nearly universal insurance coverage. Our findings emphasize the importance of investigating potential sources of disparities beyond geography and coverage.

Johns Hopkins Bloomberg School of Public Health OpenCourseWare

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Kanchanaraksa, Sukon; Gooding, Ira; Klaas, Brian; Yager, James D.

2009-01-01

The need for public health knowledge is ever increasing, but the educational options have been limited to coursework delivered by academics to individuals who can afford the cost of tuition at public health institutions. To overcome this disparity, Johns Hopkins Bloomberg School of Public Health (JHSPH) has joined the Massachusetts Institute of…

Health Literacy, Health Disparities, and Sources of Health Information in U.S. Older Adults.

Science.gov (United States)

Cutilli, Carolyn Crane; Simko, Lynn C; Colbert, Alison M; Bennett, Ian M

Low health literacy in older adults has been associated with poor health outcomes (i.e., mortality, decreased physical and cognitive functioning, and less preventive care utilization). Many factors associated with low health literacy are also associated with health disparities. Interaction with healthcare providers and sources of health information are influenced by an individual's health literacy and can impact health outcomes. This study examined the relationships between health literacy, sources of health information, and demographic/background characteristics in older adults (aged 65 years and older) related to health literacy and disparities. This descriptive, correlational study is a secondary analysis of the 2003 National Assessment of Adult Literacy, a large-scale national assessment. Older adults with lower health literacy have less income and education, rate their health as poor or fair, have visual or auditory difficulties, need help filling out forms, reading newspaper, or writing notes, and use each source of health information less (print and nonprint). Many of these characteristics and skills are predictive of health literacy and associated with health disparities. The results expand our knowledge of characteristics associated with health literacy and sources of health information used by older adults. Interventions to improve health outcomes including health disparities can focus on recognizing and meeting the health literacy demands of older adults.

An Approach to Integrating Health Disparities within Undergraduate Biomedical Engineering Education.

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Vazquez, Maribel; Marte, Otto; Barba, Joseph; Hubbard, Karen

2017-11-01

Health disparities are preventable differences in the incidence, prevalence and burden of disease among communities targeted by gender, geographic location, ethnicity and/or socio-economic status. While biomedical research has identified partial origin(s) of divergent burden and impact of disease, the innovation needed to eradicate health disparities in the United States requires unique engagement from biomedical engineers. Increasing awareness of the prevalence and consequences of health disparities is particularly attractive to today's undergraduates, who have undauntedly challenged paradigms believed to foster inequality. Here, the Department of Biomedical Engineering at The City College of New York (CCNY) has leveraged its historical mission of access-and-excellence to integrate the study of health disparities into undergraduate BME curricula. This article describes our novel approach in a multiyear study that: (i) Integrated health disparities modules at all levels of the required undergraduate BME curriculum; (ii) Developed opportunities to include impacts of health disparities into undergraduate BME research projects and mentored High School summer STEM training; and (iii) Established health disparities-based challenges as BME capstone design and/or independent entrepreneurship projects. Results illustrate the rising awareness of health disparities among the youngest BMEs-to-be, as well as abundant undergraduate desire to integrate health disparities within BME education and training.

78 FR 65345 - National Institute on Minority Health and Health Disparities; Notice of Closed Meeting

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2013-10-31

... Minority Health and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal... and Health Disparities Special Emphasis Panel; NIMHD Research Center in Minority Institution Program... applications. Place: National Institute on Minority Health and Health Disparities, 6707 Democracy Blvd., Suite...

78 FR 62638 - National Institute on Minority Health and Health Disparities; Notice of Closed Meetings

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2013-10-22

... Minority Health and Health Disparities; Notice of Closed Meetings Pursuant to section 10(d) of the Federal... Institute on Minority Health and Health Disparities Special Emphasis Panel; NIMHD Technologies for Improving Minority Health and Eliminating Health Disparities (R41/ R42). Date: November 8, 2013. Time: 8:00 a.m. to 5...

77 FR 61611 - National Institute on Minority Health and Health Disparities; Notice of Closed Meetings

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2012-10-10

... Minority Health and Health Disparities; Notice of Closed Meetings Pursuant to section 10(d) of the Federal... and Health Disparities Special Emphasis Panel; NIMHD Social, Behavioral, Health Services, and Policy Research on Minority Health and Health Disparities (R01). Date: November 7-9, 2012. Time: 8 a.m. to 3 p.m...

The Framing of Women and Health Disparities: A Critical Look at Race, Gender, and Class from the Perspectives of Grassroots Health Communicators.

Science.gov (United States)

Vardeman-Winter, Jennifer

2017-05-01

As women's health has received significant political and media attention recently, I proposed an expanded structural theory of women's communication about health. Women's health communication and critical race and systemic racism research framed this study. I interviewed 15 communicators and community health workers from grass-roots organizations focused on women's health to learn of their challenges of communicating with women from communities experiencing health disparities. Findings suggest that communicators face difficulties in developing meaningful messaging for publics because of disjunctures between medical and community frames, issues in searching for health among women's many priorities, Whiteness discourses imposed on publics' experiences, and practices of correcting for power differentials. A structural theory of women's health communication, then, consists of tenets around geographic, research/funding, academic/industry, and social hierarchies. Six frames suggesting racial biases about women and health disparities are also defined. This study also includes practical solutions in education, publishing, and policy change for addressing structural challenges.

Health disparities through a psychological lens.

Science.gov (United States)

Adler, Nancy E

2009-11-01

There is growing concern in the United States about avoidable, unjust differences in health associated with sociodemographic characteristics, such as socioeconomic status and race/ethnicity. This concern has sparked research to identify how disparities develop and how they can be reduced. Studies showing that disparities occur at all levels of socioeconomic status, not simply at the very bottom, suggest that psychosocial factors play an important role. The author discusses both content and process issues in psychological research on disparities. Copyright 2009 by the American Psychological Association

77 FR 9673 - National Institute on Minority Health and Health Disparities Notice of Closed Meeting

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2012-02-17

... Minority Health and Health Disparities Notice of Closed Meeting Pursuant to section 10(d) of the Federal... and Health Disparities Special Emphasis Panel; R01. Date: February 16, 2012. Time: 8 a.m. to 5 p.m...., Scientific Review Officer, National Institute on Minority Health and Health Disparities, National Institutes...

78 FR 10621 - National Institute on Minority Health and Health Disparities; Notice of Closed Meeting

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2013-02-14

... Minority Health and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal... and Health Disparities Special Emphasis Panel; NIMHD Conference Grant Review (R13). Date: March 15... Health Disparities, 6707 Democracy Blvd., Suite 800, Bethesda, MD 20892, (301) 594-7784, [email protected

Socioeconomic Disparities and Health: Impacts and Pathways

Science.gov (United States)

Kondo, Naoki

2012-01-01

Growing socioeconomic disparity is a global concern, as it could affect population health. The author and colleagues have investigated the health impacts of socioeconomic disparities as well as the pathways that underlie those disparities. Our meta-analysis found that a large population has risks of mortality and poor self-rated health that are attributable to income inequality. The study results also suggested the existence of threshold effects (ie, a threshold of income inequality over which the adverse impacts on health increase), period effects (ie, the potential for larger impacts in later years, specifically after the 1990s), and lag effects between income inequality and health outcomes. Our other studies using Japanese national representative survey data and a large-scale cohort study of Japanese older adults (AGES cohort) support the relative deprivation hypothesis, namely, that invidious social comparisons arising from relative deprivation in an unequal society adversely affect health. A study with a natural experiment design found that the socioeconomic gradient in self-rated health might actually have become shallower after the 1997–98 economic crisis in Japan, due to smaller health improvements among middle-class white-collar workers and middle/upper-income workers. In conclusion, income inequality might have adverse impacts on individual health, and psychosocial stress due to relative deprivation may partially explain those impacts. Any study of the effects of macroeconomic fluctuations on health disparities should also consider multiple potential pathways, including expanding income inequality, changes in the labor market, and erosion of social capital. Further studies are needed to attain a better understanding of the social determinants of health in a rapidly changing society. PMID:22156290

Socioeconomic disparities and health: impacts and pathways.

Science.gov (United States)

Kondo, Naoki

2012-01-01

Growing socioeconomic disparity is a global concern, as it could affect population health. The author and colleagues have investigated the health impacts of socioeconomic disparities as well as the pathways that underlie those disparities. Our meta-analysis found that a large population has risks of mortality and poor self-rated health that are attributable to income inequality. The study results also suggested the existence of threshold effects (ie, a threshold of income inequality over which the adverse impacts on health increase), period effects (ie, the potential for larger impacts in later years, specifically after the 1990s), and lag effects between income inequality and health outcomes. Our other studies using Japanese national representative survey data and a large-scale cohort study of Japanese older adults (AGES cohort) support the relative deprivation hypothesis, namely, that invidious social comparisons arising from relative deprivation in an unequal society adversely affect health. A study with a natural experiment design found that the socioeconomic gradient in self-rated health might actually have become shallower after the 1997-98 economic crisis in Japan, due to smaller health improvements among middle-class white-collar workers and middle/upper-income workers. In conclusion, income inequality might have adverse impacts on individual health, and psychosocial stress due to relative deprivation may partially explain those impacts. Any study of the effects of macroeconomic fluctuations on health disparities should also consider multiple potential pathways, including expanding income inequality, changes in the labor market, and erosion of social capital. Further studies are needed to attain a better understanding of the social determinants of health in a rapidly changing society.

78 FR 13689 - National Institute on Minority Health and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2013-02-28

... Minority Health and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal... and Health Disparities Special Emphasis Panel. Date: March 8, 2013. Time: 8:00 a.m. to 5:00 p.m..., and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892, (301) 496-3996...

Obesity stigma: important considerations for public health.

Science.gov (United States)

Puhl, Rebecca M; Heuer, Chelsea A

2010-06-01

Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. We examine evidence to address these assumptions and discuss their public health implications. On the basis of current findings, we propose that weight stigma is not a beneficial public health tool for reducing obesity. Rather, stigmatization of obese individuals threatens health, generates health disparities, and interferes with effective obesity intervention efforts. These findings highlight weight stigma as both a social justice issue and a priority for public health.

Prioritizing health disparities in medical education to improve care

Science.gov (United States)

Awosogba, Temitope; Betancourt, Joseph R.; Conyers, F. Garrett; Estapé, Estela S.; Francois, Fritz; Gard, Sabrina J.; Kaufman, Arthur; Lunn, Mitchell R.; Nivet, Marc A.; Oppenheim, Joel D.; Pomeroy, Claire; Yeung, Howa

2015-01-01

Despite yearly advances in life-saving and preventive medicine, as well as strategic approaches by governmental and social agencies and groups, significant disparities remain in health, health quality, and access to health care within the United States. The determinants of these disparities include baseline health status, race and ethnicity, culture, gender identity and expression, socioeconomic status, region or geography, sexual orientation, and age. In order to renew the commitment of the medical community to address health disparities, particularly at the medical school level, we must remind ourselves of the roles of doctors and medical schools as the gatekeepers and the value setters for medicine. Within those roles are responsibilities toward the social mission of working to eliminate health disparities. This effort will require partnerships with communities as well as with academic centers to actively develop and to implement diversity and inclusion strategies. Besides improving the diversity of trainees in the pipeline, access to health care can be improved, and awareness can be raised regarding population-based health inequalities. PMID:23659676

Prioritizing health disparities in medical education to improve care.

Science.gov (United States)

Awosogba, Temitope; Betancourt, Joseph R; Conyers, F Garrett; Estapé, Estela S; Francois, Fritz; Gard, Sabrina J; Kaufman, Arthur; Lunn, Mitchell R; Nivet, Marc A; Oppenheim, Joel D; Pomeroy, Claire; Yeung, Howa

2013-05-01

Despite yearly advances in life-saving and preventive medicine, as well as strategic approaches by governmental and social agencies and groups, significant disparities remain in health, health quality, and access to health care within the United States. The determinants of these disparities include baseline health status, race and ethnicity, culture, gender identity and expression, socioeconomic status, region or geography, sexual orientation, and age. In order to renew the commitment of the medical community to address health disparities, particularly at the medical school level, we must remind ourselves of the roles of doctors and medical schools as the gatekeepers and the value setters for medicine. Within those roles are responsibilities toward the social mission of working to eliminate health disparities. This effort will require partnerships with communities as well as with academic centers to actively develop and to implement diversity and inclusion strategies. Besides improving the diversity of trainees in the pipeline, access to health care can be improved, and awareness can be raised regarding population-based health inequalities. © 2013 New York Academy of Sciences.

A Study of National Physician Organizations’ Efforts to Reduce Racial and Ethnic Health Disparities in the United States

Science.gov (United States)

Peek, Monica E.; Wilson, Shannon C.; Bussey-Jones, Jada; Lypson, Monica; Cordasco, Kristina; Jacobs, Elizabeth A.; Bright, Cedric; Brown, Arleen F.

2012-01-01

Purpose To characterize national physician organizations’ efforts to reduce health disparities and identify organizational characteristics associated with such efforts. Method This cross-sectional study was conducted between September 2009 and June 2010. The authors used two-sample t tests and chi-square tests to compare the proportion of organizations with disparity-reducing activities between different organizational types (e.g., primary care versus subspecialty organizations, small [5,000 members]). Inclusion criteria required physician organizations to be (1) focused on physicians, (2) national in scope, and (3) membership based. Results The number of activities per organization ranged from 0 to 22. Approximately half (53%) of organizations had 0 or 1 disparity-reducing activities. Organiza-tional characteristics associated with having at least 1 disparity-reducing effort included membership size (88% of large groups versus 58% of small groups had at least 1 activity; P = .004) and the presence of a health disparities committee (95% versus 59%; P organizations and racial/ethnic minority physician organizations were more likely to have disparity-reducing efforts, although findings were not statistically significant. Common themes addressed by activities were health care access, health care disparities, workforce diversity, and language barriers. Common strategies included education of physicians/trainees and patients/general public, position statements, and advocacy. Conclusions Despite the national priority to eliminate health disparities, more than half of national physician organizations are doing little to address this problem. Primary care and minority physician organizations, and those with disparities committees, may provide leadership to extend the scope of disparity-reduction efforts. PMID:22534593

Feminist intersectionality: bringing social justice to health disparities research.

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Rogers, Jamie; Kelly, Ursula A

2011-05-01

The principles of autonomy, beneficence, non-maleficence, and justice are well established ethical principles in health research. Of these principles, justice has received less attention by health researchers. The purpose of this article is to broaden the discussion of health research ethics, particularly the ethical principle of justice, to include societal considerations--who and what are studied and why?--and to critique current applications of ethical principles within this broader view. We will use a feminist intersectional approach in the context of health disparities research to firmly establish inseparable links between health research ethics, social action, and social justice. The aim is to provide an ethical approach to health disparities research that simultaneously describes and seeks to eliminate health disparities. © The Author(s) 2011

Pharmacogenomics and the challenge of health disparities.

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Lee, S S

2009-01-01

This paper examines emerging technologies and recent research on population differences in pharmacogenomics and the perspectives of scientists, community advocates, policymakers, and social critics on the use of race as a proxy for genetic variation. The discussion focuses on how recent developments in genomic science impact social understandings of racial difference and the public health goal to eliminate ongoing health disparities among racially identified groups. This paper examines how factors such as governmental policies--requiring the use of racial and ethnic categories in genetic research and increasing interest in identifying untapped racial market niches by the pharmaceutical and biotechnology industries--and weak governmental oversight of race-based therapeutics converge to create an 'infrastructure of racialization' that may alter the vision of personalized medicine that has been so highly anticipated. This paper argues that significant public investment in pharmacogenomics requires careful consideration of the emerging discourse that tethers racial justice to notions of racial biology and discusses the social and ethical implications for the pendulum shift towards a geneticization of race in drug development. Copyright 2009 S. Karger AG, Basel.

Can universal coverage eliminate health disparities? Reversal of disparate injury outcomes in elderly insured minorities.

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Ramirez, Michelle; Chang, David C; Rogers, Selwyn O; Yu, Peter T; Easterlin, Molly; Coimbra, Raul; Kobayashi, Leslie

2013-06-15

Health outcome disparities in racial minorities are well documented. However, it is unknown whether such disparities exist among elderly injured patients. We hypothesized that such disparities might be reduced in the elderly owing to insurance coverage under Medicare. We investigated this issue by comparing the trauma outcomes in young and elderly patients in California. A retrospective analysis of the California Office of Statewide Health Planning and Development hospital discharge database was performed for all publicly available years from 1995 to 2008. Trauma admissions were identified by International Classification of Disease, Ninth Revision, primary diagnosis codes from 800 to 959, with certain exclusions. Multivariate analysis examined the adjusted risk of in-hospital mortality in young (<65 y) and elderly (≥65 y) patients, controlling for age, gender, injury severity as measured by the survival risk ratio, Charlson comorbidity index, insurance status, calendar year, and teaching hospital status. A total of 1,577,323 trauma patients were identified. Among the young patients, the adjusted odds ratio of death relative to non-Hispanic whites for blacks, Hispanics, Asians, and Native Americans/others was 1.2, 1.2, 0.90, and 0.78, respectively. The corresponding adjusted odds ratios of death for elderly patients were 0.78, 0.87, 0.92, and 0.61. Young black and Hispanic trauma patients had greater mortality risks relative to non-Hispanic white patients. Interestingly, elderly black and Hispanic patients had lower mortality risks compared with non-Hispanic whites. Copyright © 2013 Elsevier Inc. All rights reserved.

Physical and mental health disparities among young children of Asian immigrants.

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Huang, Keng-Yen; Calzada, Esther; Cheng, Sabrina; Brotman, Laurie Miller

2012-02-01

To examine physical and mental health functioning among Asian-American children of US-born and immigrant parents. We used data from the Early Childhood Longitudinal Study-Kindergarten Class of 1998-1999 base-year public data file. The sample was restricted to 7726 Asian and US-born white children. Asian subgroups were created based on parents' country of birth. Child physical and mental health was assessed based on multiple sources of data and measures. Analyses included multivariate linear and logistic regression. After adjusting for demographic and contextual differences, disparities were found for physical and mental health indicators. Children of foreign-born Asian families (from east, southeast, and south Asia) were at greater risk for poor physical health, internalizing problems, and inadequate interpersonal relationships compared with children of US-born white families. There is little support for the "model minority" myth with regard to physical and mental health. Evidence of physical and mental health disparities among young Asian-American children and differing risk based on region of origin of immigrant parents suggests the need for culturally informed prevention efforts during early childhood. Copyright © 2012 Mosby, Inc. All rights reserved.

Physical and Mental Health Disparities among Young Children of Asian Immigrants

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Huang, Keng-Yen; Calzada, Esther; Cheng, Sabrina; Brotman, Laurie Miller

2013-01-01

Objective To examine physical and mental health functioning among Asian-American children of US-born and immigrant parents. Study design We used data from the Early Childhood Longitudinal Study-Kindergarten Class of 1998–1999 base-year public data file. The sample was restricted to 7726 Asian and US-born white children. Asian subgroups were created based on parents’ country of birth. Child physical and mental health was assessed based on multiple sources of data and measures. Analyses included multivariate linear and logistic regression. Results After adjusting for demographic and contextual differences, disparities were found for physical and mental health indicators. Children of foreign-born Asian families (from east, southeast, and south Asia) were at greater risk for poor physical health, internalizing problems, and inadequate interpersonal relationships compared with children of US-born white families. Conclusion There is little support for the “model minority” myth with regard to physical and mental health. Evidence of physical and mental health disparities among young Asian-American children and differing risk based on region of origin of immigrant parents suggests the need for culturally informed prevention efforts during early childhood. PMID:21907351

Race-Based Health Disparities and the Digital Divide: Implications for Nursing Practice.

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Price, Zula

2015-12-01

Knowledge of the sources of race-based health disparities could improve nursing practice and education in minority underserved communities. This purpose of this paper was to consider if Black-nonBlack health disparities were at least in part explained by Black-nonBlack disparities in access to Internet-based health information. With data on the U.S. adult population from the 2012 General Social Survey, the parameters of a health production function in which computer usage as an input was estimated. It was found that while there are Black-nonBlack disparities in health, once computer usage was accounted for, Black-nonBlack health disparities disappeared. This suggests nursing and health interventions that improve Internet access for Black patients in underserved communities could improve the health of Black Americans and close the racial health disparities gap. These findings complement recent nursing researchfindings that suggest closing Black-nonBlack disparities in computer access, the "digital divide," can render nursing practice more effective in providing care to minority and underserved communities.

Identifying Health Consumers' eHealth Literacy to Decrease Disparities in Accessing eHealth Information.

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Park, Hyejin; Cormier, Eileen; Gordon, Glenna; Baeg, Jung Hoon

2016-02-01

The increasing amount of health information available on the Internet highlights the importance of eHealth literacy skills for health consumers. Low eHealth literacy results in disparities in health consumers' ability to access and use eHealth information. The purpose of this study was to assess the perceived eHealth literacy of a general health consumer population so that healthcare professionals can effectively address skills gaps in health consumers' ability to access and use high-quality online health information. Participants were recruited from three public library branches in a Northeast Florida community. The eHealth Literacy Scale was used. The majority of participants (n = 108) reported they knew how and where to find health information and how to use it to make health decisions; knowledge of what health resources were available and confidence in the ability to distinguish high- from low-quality information were considerably less. The findings suggest the need for eHealth education and support to health consumers from healthcare professionals, in particular, how to access and evaluate the quality of health information.

Intercultural Competency in Public Health: A Call for Action to Incorporate Training into Public Health Education.

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Fleckman, Julia M; Dal Corso, Mark; Ramirez, Shokufeh; Begalieva, Maya; Johnson, Carolyn C

2015-01-01

Due to increasing national diversity, programs addressing cultural competence have multiplied in U.S. medical training institutions. Although these programs share common goals for improving clinical care for patients and reducing health disparities, there is little standardization across programs. Furthermore, little progress has been made to translate cultural competency training from the clinical setting into the public health setting where the focus is on population-based health, preventative programming, and epidemiological and behavioral research. The need for culturally relevant public health programming and culturally sensitive public health research is more critical than ever. Awareness of differing cultures needs to be included in all processes of planning, implementation and evaluation. By focusing on community-based health program planning and research, cultural competence implies that it is possible for public health professionals to completely know another culture, whereas intercultural competence implies it is a dual-sided process. Public health professionals need a commitment toward intercultural competence and skills that demonstrate flexibility, openness, and self-reflection so that cultural learning is possible. In this article, the authors recommend a number of elements to develop, adapt, and strengthen intercultural competence education in public health educational institutions.

Innovative uses of electronic health records and social media for public health surveillance.

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Eggleston, Emma M; Weitzman, Elissa R

2014-03-01

Electronic health records (EHRs) and social media have the potential to enrich public health surveillance of diabetes. Clinical and patient-facing data sources for diabetes surveillance are needed given its profound public health impact, opportunity for primary and secondary prevention, persistent disparities, and requirement for self-management. Initiatives to employ data from EHRs and social media for diabetes surveillance are in their infancy. With their transformative potential come practical limitations and ethical considerations. We explore applications of EHR and social media for diabetes surveillance, limitations to approaches, and steps for moving forward in this partnership between patients, health systems, and public health.

The Politics of Race and Educational Disparities in Delaware's Public Schools

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Davis, Theodore J., Jr.

2017-01-01

Delaware has long played a pivotal role in the nation's struggle to end school segregation and promote educational equality. This article discusses racial disparities in educational achievement and outcomes by examining the state's political history and the politics of race in public education. This article explores educational disparities from a…

Foreword: Big Data and Its Application in Health Disparities Research.

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Onukwugha, Eberechukwu; Duru, O Kenrik; Peprah, Emmanuel

2017-01-01

The articles presented in this special issue advance the conversation by describing the current efforts, findings and concerns related to Big Data and health disparities. They offer important recommendations and perspectives to consider when designing systems that can usefully leverage Big Data to reduce health disparities. We hope that ongoing Big Data efforts can build on these contributions to advance the conversation, address our embedded assumptions, and identify levers for action to reduce health care disparities.

Emerging health disparities in Botswana: examining the situation of orphans during the AIDS epidemic.

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Miller, Candace Marie; Gruskin, Sofia; Subramanian, S V; Heymann, Jody

2007-06-01

Botswana has the second highest HIV prevalence rate and highest rate of orphanhood in the world. Although child mortality rates have doubled in 15 years, the extent to which health disparities are connected to orphan status remains unclear. We conducted an analysis of the 2000 Botswana Multiple Indicator Cluster Survey to examine whether orphan-based health disparities exist. We measured health inequalities using anthropometric data among 2723 under-five year olds, nested in 1854 households, and 208 communities. We calculated multilevel logistic regression models to estimate the child, household, and regional determinants of growth failure. We found that orphaned children aged 0-4 are 49% more likely to be underweight than nonorphans (ppoverty and other factors; and orphans disproportionately live in the poorest households. Throughout sub-Saharan Africa (SSA), Botswana is a leader in responding to the AIDS epidemic, in particular as one of the first countries to offer universal antiretroviral treatment. However, orphan-based health disparities confirm that the orphan response is still insufficient. Better data are needed to fully understand the mechanisms that lead to these disparities, and the public sector needs an increased capacity to fully implement the policies and programs designed to meet the needs of orphans. Findings from this study have important implications for countries throughout SSA, and Southern Africa in particular, where the number of orphans has doubled to tripled over the past 15 years.

Child Health Disparities: What Can a Clinician Do?

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Cheng, Tina L; Emmanuel, Mickey A; Levy, Daniel J; Jenkins, Renee R

2015-11-01

Pediatric primary and specialty practice has changed, with more to do, more regulation, and more family needs than in the past. Similarly, the needs of patients have changed, with more demographic diversity, family stress, and continued health disparities by race, ethnicity, and socioeconomic status. How can clinicians continue their dedicated service to children and ensure health equity in the face of these changes? This article outlines specific, practical, actionable, and evidence-based activities to help clinicians assess and address health disparities in practice. These tools may also support patient-centered medical home recognition, national and state cultural and linguistic competency standards, and quality benchmarks that are increasingly tied to payment. Clinicians can play a critical role in (1) diagnosing disparities in one's community and practice, (2) innovating new models to address social determinants of health, (3) addressing health literacy of families, (4) ensuring cultural competence and a culture of workplace equity, and (5) advocating for issues that address the root causes of health disparities. Culturally competent care that is sensitive to the needs, health literacy, and health beliefs of families can increase satisfaction, improve quality of care, and increase patient safety. Clinical care approaches to address social determinants of health and interrupting the intergenerational cycle of disadvantage include (1) screening for new health "vital signs" and connecting families to resources, (2) enhancing the comprehensiveness of services, (3) addressing family health in pediatric encounters, and (4) moving care outside the office into the community. Health system investment is required to support clinicians and practice innovation to ensure equity. Copyright © 2015 by the American Academy of Pediatrics.

Health disparities among highly vulnerable populations in the United States: a call to action for medical and oral health care

Directory of Open Access Journals (Sweden)

Allison A. Vanderbilt

2013-03-01

Full Text Available Healthcare in the United States (US is burdened with enormous healthcare disparities associated with a variety of factors including insurance status, income, and race. Highly vulnerable populations, classified as those with complex medical problems and/or social needs, are one of the fastest growing segments within the US. Over a decade ago, the US Surgeon General publically challenged the nation to realize the importance of oral health and its relationship to general health and well-being, yet oral health disparities continue to plague the US healthcare system. Interprofessional education and teamwork has been demonstrated to improve patient outcomes and provide benefits to participating health professionals. We propose the implementation of interprofessional education and teamwork as a solution to meet the increasing oral and systemic healthcare demands of highly vulnerable US populations.

The human face of health disparities.

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Green, Alexander R

2003-01-01

In the last 20 years, the issue of disparities in health between racial/ethnic groups has moved from the realm of common sense and anecdote to the realm of science. Hard, cold data now force us to consider what many had long taken for granted. Not only does health differ by race/ethnicity, but our health care system itself is deeply biased. From lack of diversity in the leadership and workforce, to ethnocentric systems of care, to biased clinical decision-making, the American health care system is geared to treat the majority, while the minority suffers. The photos shown here are of patients and scenes that recall some of the important landmarks in research on racial/ethnic disparities in health. The purpose is to put faces and humanity onto the numbers. While we now have great bodies of evidence upon which to lobby for change, in the end, each statistic still represents a personal tragedy or an individual triumph.

Integrating the 3Ds—Social Determinants, Health Disparities, and Health-Care Workforce Diversity

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Pierre, Geraldine

2014-01-01

The established relationships among social determinants of health (SDH), health disparities, and race/ethnicity highlight the need for health-care professionals to adequately address SDH in their encounters with patients. The ethnic demographic transition slated to occur during the next several decades in the United States will have numerous effects on the health-care sector, particularly as it pertains to the need for a more diverse and culturally aware workforce. In recent years, a substantial body of literature has developed, exploring the extent to which diversity in the health-care workforce may be used as a tool to eliminate racial/ethnic disparities in health and health care in the U.S. We explore existing literature on this topic, propose a conceptual framework, and identify next steps in health-care policy for reducing and eliminating health disparities by addressing SDH and diversification of the health-care workforce. PMID:24385659

Integrating the 3Ds--social determinants, health disparities, and health-care workforce diversity.

Science.gov (United States)

LaVeist, Thomas A; Pierre, Geraldine

2014-01-01

The established relationships among social determinants of health (SDH), health disparities, and race/ethnicity highlight the need for health-care professionals to adequately address SDH in their encounters with patients. The ethnic demographic transition slated to occur during the next several decades in the United States will have numerous effects on the health-care sector, particularly as it pertains to the need for a more diverse and culturally aware workforce. In recent years, a substantial body of literature has developed, exploring the extent to which diversity in the health-care workforce may be used as a tool to eliminate racial/ethnic disparities in health and health care in the U.S. We explore existing literature on this topic, propose a conceptual framework, and identify next steps in health-care policy for reducing and eliminating health disparities by addressing SDH and diversification of the health-care workforce.

75 FR 29357 - National Center on Minority and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2010-05-25

... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special NCMHD Health Disparities Research on Minority and Underserved... Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892. (301) 594-8696...

77 FR 43850 - National Institute on Minority Health and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2012-07-26

... and Health Disparities Special Emphasis Panel; NIMHD Community-Based Participatory Research (CBPR... Review Officer, National Institute on Minority Healthand Health Disparities, 6707 Democracy Blvd., Suite...

Determinants of health disparities: The perennial struggle against polio in Nigeria

Directory of Open Access Journals (Sweden)

Nosayaba Osazuwa-Peters

2011-01-01

Full Text Available Polio remains a global public health issue, and even though it has been eradicated from most countries of the world, countries like Nigeria, the largest black nation on earth, threatens the dream of total eradication of polio from the surface of the earth. Transmission of wild polio virus has never been eliminated in Nigeria, but even worse is the number of countries, both in Sub-Saharan Africa and all over the world that has become re-infected by polio virus strains from Northern Nigeria in recent past. Although a lot has been documented about the Nigerian polio struggle, one aspect that has received little attention on this issue is ethnic and geographic disparities between the Southern and the Northern parts of Nigeria. Understanding these disparities involved in polio virus transmission in Nigeria, as well as the social determinants of health prevalent in Northern Nigeria will help government and other stakeholders and policy makers to synergize their efforts in the fight against this perennial scourge.

Racializing drug design: implications of pharmacogenomics for health disparities.

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Lee, Sandra Soo-Jin

2005-12-01

Current practices of using "race" in pharmacogenomics research demands consideration of the ethical and social implications for understandings of group difference and for efforts to eliminate health disparities. This discussion focuses on an "infrastructure of racialization" created by current trajectories of research on genetic differences among racially identified groups, the use of race as a proxy for risk in clinical practice, and increasing interest in new market niches by the pharmaceutical industry. The confluence of these factors has resulted in the conflation of genes, disease, and race. I argue that public investment in pharmacogenomics requires careful consideration of current inequities in health status and social and ethical concerns over reifying race and issues of distributive justice.

[Health disparities: local realities and future challenges].

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Bodenmann, P; Green, A R

2012-11-28

Since 1887, the Policlinique Médicale Universitaire (PMU) has brought care to vulnerable populations who are at risk of poor physical, mental and social health. These include marginalised Swiss natives and immigrant communities (asylum seekers, undocumented immigrants). These patients are at risk of health disparities given their poor access to the health care system and lack of adapted quality care. Clinical approach must address these potential disparities, reinforced by a research describing them in order to explain their cause, and propose possible solutions, and a medical training addressing these topics from the undergraduate to the attending level. Through those holistic clinical approach, robust research and improved medical training, health providers will contribute to give quality care to all citizens, without exception!

76 FR 63310 - National Center On Minority and Health Disparities Notice of Closed Meetings

Science.gov (United States)

2011-10-12

... and Health Disparities Notice of Closed Meetings Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; NIMHD Health Disparities Research (R01). Date: November... Disparities, National Institutes of Health, 6707 Democracy Blvd., MSC. 5465, Suite 800, Bethesda, MD 20892...

Subjective social status, social network and health disparities: empirical evidence from Greece.

Science.gov (United States)

Charonis, Antonios; Kyriopoulos, Ilias-Ioannis; Spanakis, Manos; Zavras, Dimitris; Athanasakis, Kostas; Pavi, Elpida; Kyriopoulos, John

2017-02-27

Several studies suggest that socioeconomic status affects (SES) affects self-rated health (SRH), both in Greece and internationally. However, prior research mainly uses objective measures of SES, instead of subjective evaluations of individuals' social status. Based on this, this paper aims to examine (a) the impact of the economic dowturn on SRH in Greece and (b) the relationship between subjective social status (SSS), social network and SRH. The descriptive analysis is based on four cross-sectional surveys conducted by the National School of Public Health, Athens, Greece (2002, 2006, 2011, 2015), while the data for the empirical investigation were derived from the 2015 survey (Health + Welfare Survey GR). The empirical strategy is based on an ordinal logistic regression model, aiming to examine how several variables affect SRH. Size of social network and SSS are among the independent variables employed for the empirical analysis RESULTS: According to our findings, average SRH has deteriorated, and the percentage of the population that reports very good/good SRH has also decreased. Moreover, our empirical analysis suggests that age, existence of a chronic disease, size of social network and SSS affect SRH in Greece. Our findings are consistent with the existing literature and confirm a social gradient in health. According to our analysis, health disparities can be largely attributed to socioeconomic inequalities. The adverse economic climate has impact on socioeconomic differences which in turn affect health disparities. Based on these, policy initiatives are necessasy in order to mitigate the negative impact on health and the disparities caused by economic dowturn and the occuring socioeconomic inequalities.

The Linked CENTURY Study: linking three decades of clinical and public health data to examine disparities in childhood obesity.

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Hawkins, Summer Sherburne; Gillman, Matthew W; Rifas-Shiman, Sheryl L; Kleinman, Ken P; Mariotti, Megan; Taveras, Elsie M

2016-03-09

Despite the need to identify the causes of disparities in childhood obesity, the existing epidemiologic studies of early life risk factors have several limitations. We report on the construction of the Linked CENTURY database, incorporating CENTURY (Collecting Electronic Nutrition Trajectory Data Using Records of Youth) Study data with birth certificates; and discuss the potential implications of combining clinical and public health data sources in examining the etiology of disparities in childhood obesity. We linked the existing CENTURY Study, a database of 269,959 singleton children from birth to age 18 years with measured heights and weights, with each child's Massachusetts birth certificate, which captures information on their mothers' pregnancy history and detailed socio-demographic information of both mothers and fathers. Overall, 74.2 % were matched, resulting in 200,343 children in the Linked CENTURY Study with 1,580,597 well child visits. Among this cohort, 94.0 % (188,334) of children have some father information available on the birth certificate and 60.9 % (121,917) of children have at least one other sibling in the dataset. Using maternal race/ethnicity from the birth certificate as an indicator of children's race/ethnicity, 75.7 % of children were white, 11.6 % black, 4.6 % Hispanic, and 5.7 % Asian. Based on socio-demographic information from the birth certificate, 20.0 % of mothers were non-US born, 5.9 % smoked during pregnancy, 76.3 % initiated breastfeeding, and 11.0 % of mothers had their delivery paid for by public health insurance. Using clinical data from the CENTURY Study, 22.7 % of children had a weight-for-length ≥ 95(th) percentile between 1 and 24 months and 12.0 % of children had a body mass index ≥ 95(th) percentile at ages 5 and 17 years. By linking routinely-collected data sources, it is possible to address research questions that could not be answered with either source alone. Linkage between a clinical

Organizational Change Management For Health Equity: Perspectives From The Disparities Leadership Program.

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Betancourt, Joseph R; Tan-McGrory, Aswita; Kenst, Karey S; Phan, Thuy Hoai; Lopez, Lenny

2017-06-01

Leaders of health care organizations need to be prepared to improve quality and achieve equity in today's health care environment characterized by a focus on achieving value and addressing disparities in a diverse population. To help address this need, the Disparities Solutions Center at Massachusetts General Hospital launched the Disparities Leadership Program in 2007. The leadership program is an ongoing, year-long, executive education initiative that trains leaders from hospitals, health plans, and health centers to improve quality and eliminate racial and ethnic disparities in health care. Feedback from participating organizations demonstrates that health care leaders seem to possess knowledge about what disparities are and about what should be done to eliminate them. Data collection, performance measurement, and multifaceted interventions remain the tools of the trade. However, the barriers to success are lack of leadership buy-in, organizational prioritization, energy, and execution, which can be addressed through organizational change management strategies. Project HOPE—The People-to-People Health Foundation, Inc.

The role that graduate medical education must play in ensuring health equity and eliminating health care disparities.

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Maldonado, Maria E; Fried, Ethan D; DuBose, Thomas D; Nelson, Consuelo; Breida, Margaret

2014-05-01

Despite the 2002 Institute of Medicine report that described the moral and financial impact of health care disparities and the need to address them, it is evident that health care disparities persist. Recommendations for addressing disparities include collecting and reporting data on patient race and ethnicity, supporting language interpretation services, increasing awareness of health care disparities through education, requiring cultural competency training for all health care professionals, and increasing diversity among those delivering health care. The Accreditation Council on Graduate Medical Education places strong emphasis on graduate medical education's role in eliminating health care disparities by asking medical educators to objectively evaluate and report on their trainees' ability to practice patient-centered, culturally competent care. Moreover, one of the objectives of the Accreditation Council on Graduate Medical Education Clinical Learning Environment Review visits as part of the Next Accreditation System is to identify how sponsoring institutions engage residents and fellows in the use of data to improve systems of care, reduce health care disparities, and improve patient outcomes. Residency and fellowship programs should ensure the delivery of meaningful curricula on cultural competency and health care disparities, for which there are numerous resources, and ensure resident assessment of culturally competent care. Moreover, training programs and institutional leadership need to collaborate on ensuring data collection on patient satisfaction, outcomes, and quality measures that are broken down by patient race, cultural identification, and language. A diverse physician workforce is another strategy for mitigating health care disparities, and using strategies to enhance faculty diversity should also be a priority of graduate medical education. Transparent data about institutional diversity efforts should be provided to interested medical students

Urban poverty and infant-health disparities among African Americans and whites in Milwaukee.

Science.gov (United States)

Sims, Mario; Rainge, Yolanda

2002-06-01

This study examined neighborhood and infant health disparities between African-American and white mothers in Milwaukee, Wisconsin. Census-block data were used for 1990 and Vital Statistics data were used for 1992 through 1994. African-American mothers lived in less desirable, more segregated neighborhoods than white mothers did in 1990. African-American infant and neonatal mortality rates were twice those of whites (2.3 and 2.0, respectively), while African-American postneonatal mortality rates were three times that of whites (3.0). African-American low and very low birth weight rates were more than twice those of whites (2.5 and 2.6, respectively). All African-American mothers were nearly eight times as likely as all white mothers to have inadequate prenatal care, whereas poor African-American mothers were three times as likely to have inadequate prenatal care as were poor white mothers. Public health experts and practitioners may want to consider the communities of minority patients to devise interventions suitable for addressing health disparities.

Sociodemographic disparities in survival for adolescents and young adults with cancer differ by health insurance status.

Science.gov (United States)

DeRouen, Mindy C; Parsons, Helen M; Kent, Erin E; Pollock, Brad H; Keegan, Theresa H M

2017-08-01

To investigate associations of sociodemographic factors-race/ethnicity, neighborhood socioeconomic status (SES), and health insurance-with survival for adolescents and young adults (AYAs) with invasive cancer. Data on 80,855 AYAs with invasive cancer diagnosed in California 2001-2011 were obtained from the California Cancer Registry. We used multivariable Cox proportional hazards regression to estimate overall survival. Associations of public or no insurance with greater risk of death were observed for 11 of 12 AYA cancers examined. Compared to Whites, Blacks experienced greater risk of death, regardless of age or insurance, while greater risk of death among Hispanics and Asians was more apparent for younger AYAs and for those with private/military insurance. More pronounced neighborhood SES disparities in survival were observed among AYAs with private/military insurance, especially among younger AYAs. Lacking or having public insurance was consistently associated with shorter survival, while disparities according to race/ethnicity and neighborhood SES were greater among AYAs with private/military insurance. While health insurance coverage associates with survival, remaining racial/ethnic and socioeconomic disparities among AYAs with cancer suggest additional social factors also need consideration in intervention and policy development.

Partnering health disparities research with quality improvement science in pediatrics.

Science.gov (United States)

Lion, K Casey; Raphael, Jean L

2015-02-01

Disparities in pediatric health care quality are well described in the literature, yet practical approaches to decreasing them remain elusive. Quality improvement (QI) approaches are appealing for addressing disparities because they offer a set of strategies by which to target modifiable aspects of care delivery and a method for tailoring or changing an intervention over time based on data monitoring. However, few examples in the literature exist of QI interventions successfully decreasing disparities, particularly in pediatrics, due to well-described challenges in developing, implementing, and studying QI with vulnerable populations or in underresourced settings. In addition, QI interventions aimed at improving quality overall may not improve disparities, and in some cases, may worsen them if there is greater uptake or effectiveness of the intervention among the population with better outcomes at baseline. In this article, the authors review some of the challenges faced by researchers and frontline clinicians seeking to use QI to address health disparities and propose an agenda for moving the field forward. Specifically, they propose that those designing and implementing disparities-focused QI interventions reconsider comparator groups, use more rigorous evaluation methods, carefully consider the evidence for particular interventions and the context in which they were developed, directly engage the social determinants of health, and leverage community resources to build collaborative networks and engage community members. Ultimately, new partnerships between communities, providers serving vulnerable populations, and QI researchers will be required for QI interventions to achieve their potential related to health care disparity reduction. Copyright © 2015 by the American Academy of Pediatrics.

Poverty and elimination of urban health disparities: challenge and opportunity.

Science.gov (United States)

Thomas, Stephen B; Quinn, Sandra Crouse

2008-01-01

The aim of this article is to examine the intersection of race and poverty, two critical factors fueling persistent racial and ethnic health disparities among urban populations. From the morass of social determinants that shape the health of racial and ethnic communities in our urban centers, we will offer promising practices and potential solutions to eliminating racial and ethnic health disparities.

Social justice, health disparities, and culture in the care of the elderly.

Science.gov (United States)

Dilworth-Anderson, Peggye; Pierre, Geraldine; Hilliard, Tandrea S

2012-01-01

Older minority Americans experience worse health outcomes than their white counterparts, exhibiting the need for social justice in all areas of their health care. Justice, fairness, and equity are crucial to minimizing conditions that adversely affect the health of individuals and communities. In this paper, Alzheimer's disease (AD) is used as an example of a health care disparity among elderly Americans that requires social justice interventions. Cultural factors play a crucial role in AD screening, diagnosis, and access to care, and are often a barrier to support and equality for minority communities. The "conundrum of health disparities" refers to the interplay between disparity, social justice, and cultural interpretation, and encourages researchers to understand both (1) disparity caused by economic and structural barriers to access, treatment, and diagnosis, and (2) disparity due to cultural interpretation of disease, in order to effectively address health care issues and concerns among elderly Americans. © 2012 American Society of Law, Medicine & Ethics, Inc.

Inequity in access to dental care services explains current socioeconomic disparities in oral health: the Swedish National Surveys of Public Health 2004-2005.

Science.gov (United States)

Wamala, Sarah; Merlo, Juan; Boström, Gunnel

2006-12-01

To analyse the effects of socioeconomic disadvantage on access to dental care services and on oral health. Design, setting and outcomes: Cross-sectional data from the Swedish National Surveys of Public Health 2004 and 2005. Outcomes were poor oral health (self-rated oral health and symptoms of periodontal disease) and lack of access to dental care services. A socioeconomic disadvantage index (SDI) was developed, consisting of social welfare beneficiary, being unemployed, financial crisis and lack of cash reserves. Swedish population-based sample of 17 362 men and 20 037 women. Every instance of increasing levels of socioeconomic disadvantage was associated with worsened oral health but, simultaneously, with decreased utilisation of dental care services. After adjusting for age, men with a mild SDI compared with those with no SDI had 2.7 (95% confidence interval (CI) 2.5 to 3.0) times the odds for self-rated poor oral health, whereas odds related to severe SDI were 6.8 (95% CI 6.2 to 7.5). The corresponding values among women were 2.3 (95% CI 2.1 to 2.5) and 6.8 (95% CI 6.3 to 7.5). Nevertheless, people with severe socioeconomic disparities were 7-9 times as likely to refrain from seeking the required dental treatment. These associations persisted even after controlling for living alone, education, occupational status and lifestyle factors. Lifestyle factors explained only 29% of the socioeconomic differences in poor oral health among men and women, whereas lack of access to dental care services explained about 60%. The results of the multilevel regression analysis indicated no additional effect of the administrative boundaries of counties or of municipalities in Sweden. Results call for urgent public health interventions to increase equitable access to dental care services.

Teaching Public Health Through a Pedagogy of Collegiality

Science.gov (United States)

Chávez, Vivian; Turalba, Ruby-Asuncion N.; Malik, Savita

2006-01-01

Curriculum development in masters of public health programs that effectively meets the complex challenges of the 21st century is an important part of public health education and requires purposeful thinking. Current approaches to training the public health work-force do not adequately prepare professionals to be culturally competent in addressing health disparities. Principles of community-based participatory research highlight the importance of building relationships of mutual accountability and emphasize collegial teaching. We present background and theoretical foundations for a pedagogy of collegiality and describe specific teaching methods, classroom activities, and key assignments organized around 4 essential features: principles of community organizing, building community and valuing diversity, engaging the senses, and writing across the curriculum. PMID:16735640

Health disparities in the immunoprevention of human papillomavirus infection and associated malignancies

Directory of Open Access Journals (Sweden)

Amira eBakir

2015-12-01

Full Text Available Human papillomavirus (HPV causes about 1.6% of the roughly 1.6 million new cancer cases that are diagnosed in the United States each year. Despite the proven safety and efficacy of currently available vaccines, HPV remains the most common sexually transmitted infection. Underlying the high prevalence of HPV infection is the poor adherence to the Centers for Disease Control (CDC recommendation that all 11-12 year old males and females be vaccinated. In fact, only about 38% and 14% of eligible females and males respectively, receive the complete, three-dose immunization.Many factors are associated with missed HPV vaccination opportunities, including race, age, family income and patient education, resulting in widespread disparities in vaccination rates and related health outcomes. Beyond patient circumstance, however, research indicates that the rigor and consistency of recommendation by primary care providers also plays a significant role in uptake of HPV immunization. Health disparities data are of vital importance to HPV vaccination campaigns because they can provide insight into how to address current problems and allocate limited resources where they are most needed. Furthermore, even modest gains in populations with low vaccination rates may yield great benefits because HPV immunization has been shown to provide herd immunity, indirect protection for non-immunized individuals achieved by limiting the spread of an infectious agent through a population. HPV vaccination campaigns face the challenge of stagnant HPV immunization rates, which are increasing slowly overall but remain far below target levels. Furthermore, gains in immunization are not equal across all groups and vaccination rates are strikingly disparate across the federal poverty level. To achieve the greatest impact, public health campaigns should focus on improving vaccination coverage where it is weakest. In addition to demographics, socioeconomic factors and attitudes of

Social, Economic, and Health Disparities Among LGBT Older Adults.

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Emlet, Charles A

2016-01-01

LGBT older adults are a heterogeneous population with collective and unique strengths and challenges. Health, personal, and economic disparities exist in this group when compared to the general population of older adults, yet subgroups such as transgender and bisexual older adults and individuals living with HIV are at greater risk for disparities and poorer health outcomes. As this population grows, further research is needed on factors that contribute to promoting health equity, while decreasing discrimination and improving competent service delivery.

Understanding ethnic/racial health disparities in youth and families in the US.

Science.gov (United States)

Carlo, Gustavo; Crockett, Lisa J; Carranza, Miguel A; Martinez, Miriam M

2011-01-01

To summarize, ethnic and social class disparities are evident across a spectrum of markers of psychological, behavioral, and physical health. Furthermore, the pattern is often complex such that disparities are sometimes found within ethnic/racial groups as well as across those groups. Indeed, it is likely that the causes of health disparities may be different across specific subgroups. Moreover, theoretical models are needed that examine biological, contextual, and person-level variables (including culture-specific variables) to account for health disparities. The scholars in the present volume provide exemplary research that moves us towards more comprehensive and integrative models of health disparities. A brief glance at the work summarized by these scholars yields some common elements of focus for future researchers regarding risk (e.g., poverty, lack of contextual diversity) and protective (e.g., family support, cultural identity) factors yet they also identify aspects (e.g., genetic vulnerabilities) that may be unique to specific ethnic/racial groups. In addition to employing more integrative and culturally sensitive models of health disparities, future research studies could expand the scope of investigation to include transnational studies of health disparities and the processes contributing to them. They might also consider culture-specific health problems and syndromes such as "nervios" in Latino cultures. Within nations, further attention might be directed to the community contexts in which ethnic minority and low SES families reside, not only urban areas but the much less studied rural areas. Finally, efforts to assess health disparities and the factors contributing to them across cultural and ethnic groups need to attend closely to the issue of measurement equivalence in order to ensure valid cross-group comparisons. We would add that future research on health disparities will need to examine markers of positive health outcomes and well being (e

Cultural competence and perceptions of community health workers' effectiveness for reducing health care disparities.

Science.gov (United States)

Mobula, Linda M; Okoye, Mekam T; Boulware, L Ebony; Carson, Kathryn A; Marsteller, Jill A; Cooper, Lisa A

2015-01-01

Community health worker (CHW) interventions improve health outcomes of patients from underserved communities, but health professionals' perceptions of their effectiveness may impede integration of CHWs into health care delivery systems. Whether health professionals' attitudes and skills, such as those related to cultural competence, influence perceptions of CHWs, is unknown. A questionnaire was administered to providers and clinical staff from 6 primary care practices in Maryland from April to December 2011. We quantified the associations of self-reported cultural competence and preparedness with attitudes toward the effectiveness of CHWs using logistic regression adjusting for respondent age, race, gender, provider/staff status, and years at the practice. We contacted 200 providers and staff, and 119 (60%) participated. Those reporting more cultural motivation had higher odds of perceiving CHWs as helpful for reducing health care disparities (odds ratio [OR] = 9.66, 95% confidence interval [CI] = 3.48-28.80). Those reporting more frequent culturally competent behaviors also had higher odds of believing CHWs would help reduce health disparities (OR = 3.58, 95% CI = 1.61-7.92). Attitudes toward power and assimilation were not associated with perceptions of CHWs. Cultural preparedness was associated with perceived utility of CHWs in reducing health care disparities (OR = 2.33, 95% CI = 1.21-4.51). Providers and staff with greater cultural competence and preparedness have more positive expectations of CHW interventions to reduce healthcare disparities. Cultural competency training may complement the use of CHWs and support their effective integration into primary care clinics that are seeking to reduce disparities. © The Author(s) 2014.

Rigor, vigor, and the study of health disparities.

Science.gov (United States)

Adler, Nancy; Bush, Nicole R; Pantell, Matthew S

2012-10-16

Health disparities research spans multiple fields and methods and documents strong links between social disadvantage and poor health. Associations between socioeconomic status (SES) and health are often taken as evidence for the causal impact of SES on health, but alternative explanations, including the impact of health on SES, are plausible. Studies showing the influence of parents' SES on their children's health provide evidence for a causal pathway from SES to health, but have limitations. Health disparities researchers face tradeoffs between "rigor" and "vigor" in designing studies that demonstrate how social disadvantage becomes biologically embedded and results in poorer health. Rigorous designs aim to maximize precision in the measurement of SES and health outcomes through methods that provide the greatest control over temporal ordering and causal direction. To achieve precision, many studies use a single SES predictor and single disease. However, doing so oversimplifies the multifaceted, entwined nature of social disadvantage and may overestimate the impact of that one variable and underestimate the true impact of social disadvantage on health. In addition, SES effects on overall health and functioning are likely to be greater than effects on any one disease. Vigorous designs aim to capture this complexity and maximize ecological validity through more complete assessment of social disadvantage and health status, but may provide less-compelling evidence of causality. Newer approaches to both measurement and analysis may enable enhanced vigor as well as rigor. Incorporating both rigor and vigor into studies will provide a fuller understanding of the causes of health disparities.

Editorial: 3rd Special Issue on behavior change, health, and health disparities.

Science.gov (United States)

Higgins, Stephen T

2016-11-01

This Special Issue of Preventive Medicine (PM) is the 3rd that we have organized on behavior change, health, and health disparities. This is a topic of critical importance to improving U.S. population health. There is broad scientific consensus that personal behaviors such as cigarette smoking, other substance abuse, and physical inactivity/obesity are among the most important modifiable causes of chronic disease and its adverse impacts on population health. Hence, effectively promoting health-related behavior change needs to be a key component of health care research and policy. There is also broad recognition that while these problems extend throughout the population, they disproportionately impact economically disadvantaged populations and other vulnerable populations and represent a major contributor to health disparities. Thus, behavior change represents an essential step in curtailing health disparities, which receives special attention in this 3rd Special Issue. We also devote considerable space to the longstanding challenges of reducing cigarette smoking and use of other tobacco and nicotine delivery products in vulnerable populations, obesity, and for the first time food insecurity. Across each of these topics we include contributions from highly accomplished policymakers and scientists to acquaint readers with recent accomplishments as well as remaining knowledge gaps and challenges. Copyright © 2016 Elsevier Inc. All rights reserved.

The Biology of Cancer Health Disparities

Science.gov (United States)

These examples show how biology contributes to health disparities (differences in disease incidence and outcomes among distinct racial and ethnic groups, ), and how biological factors interact with other relevant factors, such as diet and the environment.

Assessing the contribution of the dental care delivery system to oral health care disparities.

Science.gov (United States)

Pourat, Nadereh; Andersen, Ronald M; Marcus, Marvin

2015-01-01

Existing studies of disparities in access to oral health care for underserved populations often focus on supply measures such as number of dentists. This approach overlooks the importance of other aspects of the dental care delivery system, such as personal and practice characteristics of dentists, that determine the capacity to provide care. This study aims to assess the role of such characteristics in access to care of underserved populations. We merged data from the 2003 California Health Interview Survey and a 2003 survey of California dentists in their Medical Study Service Areas (MSSAs). We examined the role of overall supply and other characteristics of dentists in income and racial/ethnic disparities in access, which was measured by annual dental visits and unmet need for dental care due to costs. We found that some characteristics of MSSAs, including higher proportions of dentists who were older, white, busy or overworked, and did not accept public insurance or discounted fees, inhibited access for low-income and minority populations. These findings highlight the importance of monitoring characteristics of dentists in addition to traditional measures of supply such as licensed-dentist-to-population ratios. The findings identify specific aspects of the delivery system such as dentists' participation in Medicaid, provision of discounted care, busyness, age, race/ethnicity, and gender that should be regularly monitored. These data will provide a better understanding of how the dental care delivery system is organized and how this knowledge can be used to develop more narrowly targeted policies to alleviate disparities. © 2014 American Association of Public Health Dentistry.

Decreasing health disparities for people with disabilities through improved communication strategies and awareness.

Science.gov (United States)

Sharby, Nancy; Martire, Katharine; Iversen, Maura D

2015-03-19

Factors influencing access to health care among people with disabilities (PWD) include: attitudes of health care providers and the public, physical barriers, miscommunication, income level, ethnic/minority status, insurance coverage, and lack of information tailored to PWD. Reducing health care disparities in a population with complex needs requires implementation at the primary, secondary and tertiary levels. This review article discusses common barriers to health care access from the patient and provider perspective, particularly focusing on communication barriers and how to address and ameliorate them. Articles utilized in this review were published from 2005 to present in MEDLINE and CINAHL and written in English that focused on people with disabilities. Topics searched for in the literature include: disparities and health outcomes, health care dissatisfaction, patient-provider communication and access issues. Ineffective communication has significant impacts for PWD. They frequently believe that providers are not interested in, or sensitive to their particular needs and are less likely to seek care or to follow up with recommendations. Various strategies for successful improvement of health outcomes for PWD were identified including changing the way health care professionals are educated regarding disabilities, improving access to health care services, and enhancing the capacity for patient centered care.

Disparities in public and private pre-primary and primary schools ...

African Journals Online (AJOL)

International Journal of Development and Management Review ... essential for educational planning; their disparities in public and private pre-primary and ... teaching as a career especially in the private schools where they constitute only 35.

76 FR 18566 - National Center on Minority and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2011-04-04

... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel, NIMHD Conference Grant Application (R13) Review. Date... Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892, (301) 451-9536...

Health disparities in liver disease in sub-Saharan Africa.

Science.gov (United States)

Spearman, C Wendy; Sonderup, Mark W

2015-09-01

Disparities in health reflect the differences in the incidence, prevalence, burden of disease and access to care determined by socio-economic and environmental factors. With liver disease, these disparities are exacerbated by a combination of limited awareness and preventable causes of morbidity and mortality in addition to the diagnostic and management costs. Sub-Saharan Africa, comprising 11% of the world's population, disproportionately has 24% of the global disease burden, yet allocates health. It has 3% of the global healthcare workforce with a mean of 0.8 healthcare workers per 1000 population. Barriers to healthcare access are many and compounded by limited civil registration data, socio-economic inequalities, discrepancies in private and public healthcare services and geopolitical strife. The UN 2014 report on the Millennium Development Goals suggest that sub-Saharan Africa will probably not meet several goals, however with HIV/AIDS and Malaria (goal 6), many successes have been achieved. A 2010 Global Burden of Disease study demonstrated that cirrhosis mortality in sub-Saharan Africa doubled between 1980 and 2010. Aetiologies included hepatitis B (34%), hepatitis C (17%), alcohol (18%) and unknown in 31%. Hepatitis B, C and alcohol accounted for 47, 23 and 20% of hepatocellular carcinoma respectively. In 10%, the underlying aetiology was not known. Liver disease reflects the broader disparities in healthcare in sub-Saharan Africa. However, many of these challenges are not insurmountable as vaccines and new therapies could comprehensively deal with the burden of viral hepatitis. Access to and affordability of therapeutics remains the major barrier. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Implementing the Institute of Medicine definition of disparities: an application to mental health care.

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McGuire, Thomas G; Alegria, Margarita; Cook, Benjamin L; Wells, Kenneth B; Zaslavsky, Alan M

2006-10-01

In a recent report, the Institute of Medicine (IOM) defines a health service disparity between population groups to be the difference in treatment or access not justified by the differences in health status or preferences of the groups. This paper proposes an implementation of this definition, and applies it to disparities in outpatient mental health care. Health Care for Communities (HCC) reinterviewed 9,585 respondents from the Community Tracking Study in 1997-1998, oversampling individuals with psychological distress, alcohol abuse, drug abuse, or mental health treatment. The HCC is designed to make national estimates of service use. Expenditures are modeled using generalized linear models with a log link for quantity and a probit model for any utilization. We adjust for group differences in health status by transforming the entire distribution of health status for minority populations to approximate the white distribution. We compare disparities according to the IOM definition to other methods commonly used to assess health services disparities. Our method finds significant service disparities between whites and both blacks and Latinos. Estimated disparities from this method exceed those for competing approaches, because of the inclusion of effects of mediating factors (such as income) in the IOM approach. A rigorous definition of disparities is needed to monitor progress against disparities and to compare their magnitude across studies. With such a definition, disparities can be estimated by adjusting for group differences in models for expenditures and access to mental health services.

76 FR 40384 - National Center on Minority and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2011-07-08

... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special, Emphasis Panel, U24 Grant Review. Date: July 11-12, 2011. Time: 8 a.m..., National Institute on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda...

76 FR 11500 - National Center on Minority and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2011-03-02

... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; R01 grant review (03). Date: March 7, 2011. Time: 8 a.m... Health Disparities, National Institutes of Health, 6707 Democracy Boulevard, Suite 800, Bethesda, MD...

76 FR 28795 - National Center on Minority and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2011-05-18

... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; R25 Grant Review. Date: May 23-24, 2011. Time: 8 a.m..., National Institute on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda...

75 FR 25273 - National Center on Minority and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2010-05-07

... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel, Faith Based R21. Date: June 29-July 1, 2010. Time: 5 p..., Chief, Office of Scientific Review, National Center on Minority Health and Health Disparities, 6707...

Islamophobia and Public Health in the United States.

Science.gov (United States)

Samari, Goleen

2016-11-01

Anti-Muslim sentiments are increasingly common globally and in the United States. The recent rise in Islamophobia calls for a public health perspective that considers the stigmatized identity of Muslim Americans and health implications of Islamophobic discrimination. Drawing on a stigma, discrimination, and health framework, I expand the dialogue on the rise of Islamophobia to a discussion of how Islamophobia affects the health of Muslim Americans. Islamophobia can negatively influence health by disrupting several systems-individual (stress reactivity and identity concealment), interpersonal (social relationships and socialization processes), and structural (institutional policies and media coverage). Islamophobia deserves attention as a source of negative health outcomes and health disparities. Future public health research should explore the multilevel and multidimensional pathways between Islamophobia and population health.

Effect of Medicaid Managed Care on racial disparities in health care access.

Science.gov (United States)

Cook, Benjamin Lê

2007-02-01

To evaluate the impact of Medicaid Managed Care (MMC) on racial disparities in access to care consistent with the Institute of Medicine (IOM) definition of racial disparity, which excludes differences stemming from health status but includes socioeconomic status (SES)-mediated differences. Secondary data from the Adult Samples of the 1997-2001 National Health Interview Survey, metropolitan statistical area (MSA)-level Medicaid Health Maintenance Organization (MHMO) market share from the 1997 to 2001 InterStudy MSA Trend Dataset, and MSA characteristics from the 1997 to 2001 Area Resource File. I estimate multivariate regression models to compare racial disparities in doctor visits, emergency room (ER) use, and having a usual source of care between enrollees in MMC and Medicaid Fee-for-Service (FFS) plans. To contend with potential selection bias, I use a difference-in-difference analytical strategy and assess the impact of greater MHMO market share at the MSA level on Medicaid enrollees' access measures. To implement the IOM definition of racial disparity, I adjust for health status but not SES factors using a novel method to transform the distribution of health status for minority populations to approximate the white health status distribution. MMC enrollment is associated with lowered disparities in having any doctor visit in the last year for blacks, and in having any usual source of care for both blacks and Hispanics. Increasing Medicaid HMO market share lowered disparities in having any doctor visits in the last year for both blacks and Hispanics. Although disparities in most other measures were not much affected, black-white ER use disparities exist among MMC enrollees and in areas of high MHMO market share. MMC programs' reduction of some disparities suggests that recent shifts in Medicaid policy toward managed care plans have benefited minority enrollees. Future research should investigate whether black-white disparities in ER use within MMC groups

75 FR 71449 - National Center on Minority and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2010-11-23

... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel (R01). Date: December 15-16, 2010. Time: 7:45 a.m. to 3..., National Institute on Minority Health and Health Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda...

Health Care Disparities Among English-Speaking and Spanish-Speaking Women With Pelvic Organ Prolapse at Public and Private Hospitals: What Are the Barriers?

Science.gov (United States)

Alas, Alexandriah N; Dunivan, Gena C; Wieslander, Cecelia K; Sevilla, Claudia; Barrera, Biatris; Rashid, Rezoana; Maliski, Sally; Eilber, Karen; Rogers, Rebecca G; Anger, Jennifer Tash

The objective of this study was to compare perceptions and barriers between Spanish-speaking and English-speaking women in public and private hospitals being treated for pelvic organ prolapse (POP). Eight focus groups, 4 in English and 4 in Spanish, were conducted at 3 institutions with care in female pelvic medicine and reconstructive surgery. Standardized questions were asked regarding patients' emotions to when they initially noticed the POP, if they sought family support, and their response to the diagnosis and treatment. Transcripts were analyzed using grounded theory qualitative methods. Thirty-three women were Spanish-speaking and 25 were English-speaking. Spanish speakers were younger (P = 0.0469) and less likely to have a high school diploma (P speaking women had more concerns that the bulge or treatments could lead to cancer, were more resistant to treatment options, and were less likely to be offered surgery. Women in the private hospital desired more information, were less embarrassed, and were more likely to be offered surgery as first-line treatment. The concept emerged that patient care for POP varied based on socioeconomic status and language and suggested the presence of disparities in care for underserved women with POP. The discrepancies in care for Spanish-speaking women and women being treated at public hospitals suggest that there are disparities in care for POP treatment for underserved women. These differences may be secondary to profit-driven pressures from private hospitals or language barriers, low socioeconomic status, low health literacy, and barriers to health care.

The influence of health disparities on targeting cancer prevention efforts.

Science.gov (United States)

Zonderman, Alan B; Ejiogu, Ngozi; Norbeck, Jennifer; Evans, Michele K

2014-03-01

Despite the advances in cancer medicine and the resultant 20% decline in cancer death rates for Americans since 1991, there remain distinct cancer health disparities among African Americans, Hispanics, Native Americans, and the those living in poverty. Minorities and the poor continue to bear the disproportionate burden of cancer, especially in terms of stage at diagnosis, incidence, and mortality. Cancer health disparities are persistent reminders that state-of-the-art cancer prevention, diagnosis, and treatment are not equally effective for and accessible to all Americans. The cancer prevention model must take into account the phenotype of accelerated aging associated with health disparities as well as the important interplay of biological and sociocultural factors that lead to disparate health outcomes. The building blocks of this prevention model will include interdisciplinary prevention modalities that encourage partnerships across medical and nonmedical entities, community-based participatory research, development of ethnically and racially diverse research cohorts, and full actualization of the prevention benefits outlined in the 2010 Patient Protection and Affordable Care Act. However, the most essential facet should be a thoughtful integration of cancer prevention and screening into prevention, screening, and disease management activities for hypertension and diabetes mellitus because these chronic medical illnesses have a substantial prevalence in populations at risk for cancer disparities and cause considerable comorbidity and likely complicate effective treatment and contribute to disproportionate cancer death rates. Published by Elsevier Inc.

Disparities in Gynecological Malignancies

Directory of Open Access Journals (Sweden)

Sudeshna eChatterjee

2016-02-01

Full Text Available Objectives: Health disparities and inequalities in access to care among different socioeconomic, ethnic, and racial groups have been well documented in the U.S. healthcare system. In this review, we aimed to provide an overview of barriers to care contributing to health disparities in gynecological oncology management and to describe site-specific disparities in gynecologic care for endometrial, ovarian, and cervical cancer. Methods: We performed a literature review of peer-reviewed academic and governmental publications focusing on disparities in gynecological care in the United States by searching PubMed and Google Scholar electronic databases. Results: There are multiple important underlying issues that may contribute to the disparities in gynecological oncology management in the United States, namely geographic access and hospital based-discrepancies, research-based discrepancies, influence of socioeconomic and health insurance status, and finally the influence of race and biological factors. Despite the reduction in overall cancer-related deaths since the 1990s, the 5-year survival for Black women is significantly lower than for White women for each gynecologic cancer type and each stage of diagnosis. For ovarian and endometrial cancer, black patients are less likely to receive treatment consistent with evidence-based guidelines and have worse survival outcomes even after accounting for stage and comorbidities. For cervical and endometrial cancer, the mortality rate for black women remains twice that of White women. Conclusions: Health care disparities in the incidence and outcome of gynecologic cancers are complex and involve biologic factors as well as racial, socioeconomic and geographic barriers that influence treatment and survival. These barriers must be addressed to provide optimal care to women in the U.S. with gynecologic cancer.

DEFINING THE "COMMUNITY" FOR A COMMUNITY-BASED PUBLIC HEALTH INTERVENTION ADDRESSING LATINO IMMIGRANT HEALTH DISPARITIES: AN APPLICATION OF ETHNOGRAPHIC METHODS.

Science.gov (United States)

Edberg, Mark; Cleary, Sean; Simmons, Lauren B; Cubilla-Batista, Idalina; Andrade, Elizabeth L; Gudger, Glencora

2015-01-01

Although Latino and other immigrant populations are the driving force behind population increases in the U.S., there are significant gaps in knowledge and practice on addressing health disparities in these populations. The Avance Center for the Advancement of Immigrant/Refugee Health, a health disparities research center in the Washington, DC area, includes as part of its mission a multi-level, participatory community intervention (called Adelante) to address the co-occurrence of substance abuse, violence and sex risk among Latino immigrant youth and young adults. Research staff and community partners knew that the intervention community had grown beyond its Census-designated place (CDP) boundaries, and that connection and attachment to community were relevant to an intervention. Thus, in order to understand current geographic and social boundaries of the community for sampling, data collection, intervention design and implementation, the research team conducted an ethnographic study to identify self-defined community boundaries, both geographic and social. Beginning with preliminary data from a pilot intervention and the original CDP map, the research included: geo-mapping de-identified addresses of service clients from a major community organization; key informant interviews; and observation and intercept interviews in the community. The results provided an expanded community boundary profile and important information about community identity.

Racial and ethnic disparities in children's oral health: the National Survey of Children's Health.

Science.gov (United States)

Dietrich, Thomas; Culler, Corinna; Garcia, Raul I; Henshaw, Michelle M

2008-11-01

The authors evaluated racial/ethnic differences and their socioeconomic determinants in the oral health status of U.S. children, as reported by parents. The authors used interview data from the 2003 National Survey of Children's Health, a large representative survey of U.S. children. They calculated weighted, nationally representative prevalence estimates for non-Hispanic whites, non-Hispanic blacks and Hispanics, and they used logistic regression to explore the association between parents' reports of fair or poor oral health and various socioeconomic determinants of oral health. The results showed significant racial/ethnic differences in parental reports of fair or poor oral health, with prevalences of 6.5 percent for non-Hispanic whites, 12.0 percent for non-Hispanic blacks and 23.4 percent for Hispanics. Although adjustments for family socioeconomic status (poverty level and education) partially explained these racial/ethnic disparities, Hispanics still were twice as likely as non-Hispanic whites to report their children's oral health as fair or poor, independent of socioeconomic status. The authors did find differences in preventive-care attitudes among groups. However, in multivariate models, such differences did not explain the disparities. Significant racial/ethnic disparities exist in parental reports of their children's oral health, with Hispanics being the most disadvantaged group. Disparities appear to exist independent of preventive-care attitudes and socioeconomic status.

75 FR 42100 - National Center on Minority and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2010-07-20

... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel, NCMHD Social Determinants of Health (R01) Panel. Date... Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892, (301) 594-8696, [email protected

Individual Breast Cancer risk assessment in Underserved Populations: Integrating empirical Bioethics and Health Disparities Research

Science.gov (United States)

Anderson, Emily E.; Hoskins, Kent

2013-01-01

Research suggests that individual breast cancer risk assessment may improve adherence to recommended screening and prevention guidelines, thereby decreasing morbidity and mortality. Further research on the use of risk assessment models in underserved minority populations is critical to informing national public health efforts to eliminate breast cancer disparities. However, implementing individual breast cancer risk assessment in underserved patient populations raises particular ethical issues that require further examination. After reviewing these issues, we will discuss how empirical bioethics research can be integrated with health disparities research to inform the translation of research findings. Our in-progress National Cancer Institute (NCI) funded study, How Do Underserved Minority Women Think About Breast Cancer?, conducted in the context of a larger study on individual breast cancer risk assessment, is presented as a model. PMID:23124498

76 FR 52959 - National Center on Minority and Health Disparities; Notice of Closed Meetings

Science.gov (United States)

2011-08-24

... and Health Disparities; Notice of Closed Meetings Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; NIMHD Revision Applications to Support Environmental Health Disparities Research P20. Date: August 29, 2011. Time: 8 a.m. to 12 p.m. Agenda: To review and...

Addressing the Social Determinants of Health to Reduce Tobacco-Related Disparities.

Science.gov (United States)

Garrett, Bridgette E; Dube, Shanta R; Babb, Stephen; McAfee, Tim

2015-08-01

Comprehensive tobacco prevention and control efforts that include implementing smoke-free air laws, increasing tobacco prices, conducting hard-hitting mass media campaigns, and making evidence-based cessation treatments available are effective in reducing tobacco use in the general population. However, if these interventions are not implemented in an equitable manner, certain population groups may be left out causing or exacerbating disparities in tobacco use. Disparities in tobacco use have, in part, stemmed from inequities in the way tobacco control policies and programs have been adopted and implemented to reach and impact the most vulnerable segments of the population that have the highest rates of smokings (e.g., those with lower education and incomes). Education and income are the 2 main social determinants of health that negatively impact health. However, there are other social determinants of health that must be considered for tobacco control policies to be effective in reducing tobacco-related disparities. This article will provide an overview of how tobacco control policies and programs can address key social determinants of health in order to achieve equity and eliminate disparities in tobacco prevention and control. Tobacco control policy interventions can be effective in addressing the social determinants of health in tobacco prevention and control to achieve equity and eliminate tobacco-related disparities when they are implemented consistently and equitably across all population groups. Taking a social determinants of health approach in tobacco prevention and control will be necessary to achieve equity and eliminate tobacco-related disparities. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Health Disparities in Pediatric Asthma: Comprehensive Tertiary Care Center Experience.

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Holmes, Laurens; Kalle, Fanta; Grinstead, Laura; Jimenez, Maritza; Murphy, Meghan; Oceanic, Pat; Fitzgerald, Diane; Dabney, Kirk

2015-03-01

Study conducted at Nemours /Alfred I. duPont Hospital for Children, Wilmington, DE 19803 BACKGROUND: Although the treatment and management of asthma hasimproved over time, incidence and prevalence among children continues to rise in the United States. Asthma prevalence, health services utilization, and mortality rate demonstrate remarkable disparities. The underlying causes of these disparities are not fully understood. We aimed to examine racial/ethnic variances in pediatric asthma prevalence/admission. We retrospectively reviewed data on 1070 patients and applied a cross-sectional design to assess asthma admission between 2010 and 2011. Information was available on race/ethnicity, sex, insurance status, severity of illness (SOI), and length of stay/hospitalization (LOS).Chi-square statistic was used for the association between race and other variables in an attempt to explain the racial/ethnic variance. The proportionate morbidity of asthma was highest amongCaucasians (40.92%) and African Americans (40.54%), intermediate among others (16.57%), and lowest among Asian (0.56%), American Indian/Alaska Native (0.28%), and Hawaiian Native/Pacific Islander (0.28%). Overall there were disparities by sex, with more boys (61.80%) diagnosed with asthma than girls (38.20%), χ2(7)=20.1, p=0.005. Insurance status, and SOI varied by race/ethnicity, but not LOS. Caucasian children were more likely to have private insurance, while African Americans and Hispanics were more likely to have public insurance (p<0.005). Asthma was more severe among non-Hispanic children, χ2(14)=154.6, p<0.001. While the overall readmission proportion was 2.8%, readmission significantly varied by race/ethnicity. Racial/ethnic disparities in asthma admission exist among children in the Delaware Valley. There were racial/ethnic disparities in insurance status, asthma severity, and sex differed by race/ethnicity, but not in length of hospitalization. © 2015 National Medical Association. Published by

Educating clinicians about cultural competence and disparities in health and health care.

Science.gov (United States)

Like, Robert C

2011-01-01

An extensive body of literature has documented significant racial and ethnic disparities in health and health care. Cultural competency interventions, including the training of physicians and other health care professionals, have been proposed as a key strategy for helping to reduce these disparities. The continuing medical education (CME) profession can play an important role in addressing this need by improving the quality and assessing the outcomes of multicultural education programs. This article provides an overview of health care policy, legislative, accreditation, and professional initiatives relating to these subjects. The status of CME offerings on cultural competence/disparities is reviewed, with examples provided of available curricular resources and online courses. Critiques of cultural competence training and selected studies of its effectiveness are discussed. The need for the CME profession to become more culturally competent in its development, implementation, and evaluation of education programs is examined. Future challenges and opportunities are described, and a call for leadership and action is issued. Copyright © 2010 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Solving Disparities Through Payment And Delivery System Reform: A Program To Achieve Health Equity.

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DeMeester, Rachel H; Xu, Lucy J; Nocon, Robert S; Cook, Scott C; Ducas, Andrea M; Chin, Marshall H

2017-06-01

Payment systems generally do not directly encourage or support the reduction of health disparities. In 2013 the Finding Answers: Solving Disparities through Payment and Delivery System Reform program of the Robert Wood Johnson Foundation sought to understand how alternative payment models might intentionally incorporate a disparities-reduction component to promote health equity. A qualitative analysis of forty proposals to the program revealed that applicants generally did not link payment reform tightly to disparities reduction. Most proposed general pay-for-performance, global payment, or shared savings plans, combined with multicomponent system interventions. None of the applicants proposed making any financial payments contingent on having successfully reduced disparities. Most applicants did not address how they would optimize providers' intrinsic and extrinsic motivation to reduce disparities. A better understanding of how payment and care delivery models might be designed and implemented to reduce health disparities is essential. Project HOPE—The People-to-People Health Foundation, Inc.

January Monthly Spotlight: Cervical Health and Cervical Cancer Disparities

Science.gov (United States)

In January, CRCHD joins the nation in raising awareness for Cervical Health and Cervical Cancer Disparities. This month we share a special focus on NCI/CRCHD research programs that are trying to reduce cervical cancer disparities in underserved communities and the people who are spreading the word about the importance of early detection.

2016 Survey of State-Level Health Resources for Men and Boys: Identification of an Inadvertent and Remediable Service and Health Disparity.

Science.gov (United States)

Fadich, Ana; Llamas, Ramon P; Giorgianni, Salvatore; Stephenson, Colin; Nwaiwu, Chimezie

2018-03-01

This survey evaluated resources available to men and boys at the state level including state public health departments (SPHDs), other state agencies, and governor's offices. Most of the resources and programs are found in the SPHDs and these administer state-initiated and federally funded health programs to provide services and protection to a broad range of populations; however, many men's health advocates believe that SPHDs have failed to create equivalent services for men and boys, inadvertently creating a health disparity. Men's Health Network conducts a survey of state resources, including those found in SPHDs, every 2 years to identify resources available for men and women, determine the extent of any disparity, and establish a relationship with SPHD officials. Data were obtained from all 50 states and Washington, D.C. An analysis of the 2016 survey data indicates that there are few resources allocated and a lack of readily available information on health and preventive care created specifically for men and boys. The data observed that most health information intended for men and boys was scarce among states or oftentimes included on websites that primarily focused on women's health. A potential result of this is a loss of engagement with appropriate health-care providers due to a lack of information. This study continues to validate the disparity between health outcomes for women and men. It continues to highlight the need for better resource allocation, outreach, and health programs specifically tailored to men and boys in order to improve overall community well-being.

The Struggle for the Soul of Public Health.

Science.gov (United States)

Wiley, Lindsay F

2016-12-01

Prevention has become a central focus for health care payers, providers, policy makers, and the general public. Given the centrality of prevention to public health science, practice, and law, it would seem that conditions are ripe for the public health law renaissance to expand beyond legal and scientific circles to permeate the general consciousness. Yet, public health law and policy interventions continue to face considerable political and legal opposition. The population perspective-which emphasizes the social determinants of health, collective action to create healthier communities, and communitarian rationales for prioritizing health-is as important to public health problem-solving as the prevention orientation. But it conflicts with the individualistic orientation that dominates American legal, cultural, and social discourse. This article suggests that public health law and policy debates offer important opportunities for public health advocates to reach across silos to promote the population perspective that unites the field. The article explores contrasting explanations for disease, injury, premature death, and health disparities offered by the population perspective and the individualistic orientation; political and cultural barriers that stand in the way of innovative law and policy interventions; and normative tensions between the communitarian population perspective and self-interested rationales for investment in prevention. Copyright © 2016 by Duke University Press.

Exploring socioeconomic disparities in self-reported oral health among adolescents in california.

Science.gov (United States)

Telford, Claire; Coulter, Ian; Murray, Liam

2011-01-01

Socioeconomic factors are associated with disparities in oral health among adolescents; however, the underlying reasons are not clear. The authors conducted a study to determine if known indicators of oral health can explain such disparities. The authors examined data from a 2007 California Health Interview Survey of adolescents. The outcome of interest was self-reported condition of the teeth; covariates were socioeconomic status (SES) (that is, family poverty level and parental education) and a range of other variables representing health-influencing behaviors, dental care and other social factors. The authors conducted analyses by using logistic regression to explain disparities in self-reported condition of the teeth associated with SES. The authors found that socioeconomic disparities decreased substantially after they added all potential explanatory variables to the model, leaving poverty level as the only variable associated with differences in the self-reported condition of the teeth. Adolescents living below the federal poverty guidelines were more likely to report that the condition of their teeth was fair or poor than were adolescents who were least poor (odds ratio = 1.58; 95 percent confidence interval, 1.04-2.41). In multivariate analyses, further oral health disparities existed in relation to behaviors that influence health, social environment and dental care. The results of this study showed that a number of factors decreased, but did not eliminate, the observed relationship between SES and oral health in Californian adolescents. Most of these explanatory factors are modifiable, indicating that socioeconomic differences associated with oral health among adolescents may be amenable to change. Practice Implications. By promoting a healthy lifestyle (including healthy diet, exercise and regular dental attendance) and conveying to patients in languages other than English how to maintain oral health, dentists may be able to ameliorate the effects of

Inpatient care expenditure of the elderly with chronic diseases who use public health insurance: Disparity in their last year of life.

Science.gov (United States)

Chandoevwit, Worawan; Phatchana, Phasith

2018-06-01

The Thai elderly are eligible for the Civil Servant Medical Benefit Scheme (CS) or Universal Coverage Scheme (UCS) depending on their pre-retirement or their children work status. This study aimed to investigate the disparity in inpatient care expenditures in the last year of life among Thai elderly individuals who used the two public health insurance schemes. Using death registration and inpatient administrative data from 2007 to 2011, our subpopulation group included the elderly with four chronic disease groups: diabetes mellitus, hypertension and cardiovascular disease, heart disease, and cancer. Among 1,242,150 elderly decedents, about 40% of them had at least one of the four chronic disease conditions and were hospitalized in their last year of life. The results showed that the means of inpatient care expenditures in the last year of life paid by CS and UCS per decedent were 99,672 Thai Baht and 52,472 Thai Baht, respectively. On average, UCS used higher healthcare resources by diagnosis-related group relative weight measure per decedent compared with CS. In all cases, the rates of payment for inpatient treatment per diagnosis-related group adjusted relative weight were higher for CS than UCS. This study found that the disparities in inpatient care expenditures in the last year of life stemmed mainly from the difference in payment rates. To mitigate this disparity, unified payment rates for various types of treatment that reflect costs of hospital care across insurance schemes were recommended. Copyright © 2018 Elsevier Ltd. All rights reserved.

Health disparities monitoring in the U.S.: lessons for monitoring efforts in Israel and other countries.

Science.gov (United States)

Abu-Saad, Kathleen; Avni, Shlomit; Kalter-Leibovici, Ofra

2018-02-28

Health disparities are a persistent problem in many high-income countries. Health policymakers recognize the need to develop systematic methods for documenting and tracking these disparities in order to reduce them. The experience of the U.S., which has a well-established health disparities monitoring infrastructure, provides useful insights for other countries. This article provides an in-depth review of health disparities monitoring in the U.S. Lessons of potential relevance for other countries include: 1) the integration of health disparities monitoring in population health surveillance, 2) the role of political commitment, 3) use of monitoring as a feedback loop to inform future directions, 4) use of monitoring to identify data gaps, 5) development of extensive cross-departmental cooperation, and 6) exploitation of digital tools for monitoring and reporting. Using Israel as a case in point, we provide a brief overview of the healthcare and health disparities landscape in Israel, and examine how the lessons from the U.S. experience might be applied in the Israeli context. The U.S. model of health disparities monitoring provides useful lessons for other countries with respect to documentation of health disparities and tracking of progress made towards their elimination. Given the persistence of health disparities both in the U.S. and Israel, there is a need for monitoring systems to expand beyond individual- and healthcare system-level factors, to incorporate social and environmental determinants of health as health indicators/outcomes.

Public health informatics in India: the potential and the challenges.

Science.gov (United States)

Athavale, A V; Zodpey, Sanjay P

2010-01-01

Public health informatics is emerging as a new and distinct specialty area in the global scenario within the broader discipline of health informatics. The potential role of informatics in reducing health disparities in underserved populations has been identified by a number of reports from all over the world. The article discusses the scope, the limitations, and future perspective of this novice discipline in context to India. It also highlights information and technology related tools namely Geographical Information Systems, Telemedicine and Electronic Medical Record/Electronic Health Record. India needs to leverage its "technology" oriented growth until now (e.g., few satellite-based telemedicine projects, etc.) simultaneously toward development of "information"-based public health informatics systems in future. Under the rapidly evolving scenario of global public health, the future of the public health governance and population health in India would depend upon building and integrating the comprehensive and responsive domain of public health informatics.

Population disparities in mental health: insights from cultural neuroscience.

Science.gov (United States)

Chiao, Joan Y; Blizinsky, Katherine D

2013-10-01

By 2050, nearly 1 in 5 Americans (19%) will be an immigrant, including Hispanics, Blacks, and Asians, compared to the 1 in 8 (12%) in 2005. They will vary in the extent to which they are at risk for mental health disorders. Given this increase in cultural diversity within the United States and costly population health disparities across cultural groups, it is essential to develop a more comprehensive understanding of how culture affects basic psychological and biological mechanisms. We examine these basic mechanisms that underlie population disparities in mental health through cultural neuroscience. We discuss the challenges to and opportunities for cultural neuroscience research to determine sociocultural and biological factors that confer risk for and resilience to mental health disorders across the globe.

The role of food culture and marketing activity in health disparities.

Science.gov (United States)

Williams, Jerome D; Crockett, David; Harrison, Robert L; Thomas, Kevin D

2012-11-01

Marketing activities have attracted increased attention from scholars interested in racial disparities in obesity prevalence, as well as the prevalence of other preventable conditions. Although reducing the marketing of nutritionally poor foods to racial/ethnic communities would represent a significant step forward in eliminating racial disparities in health, we focus instead on a critical-related question. What is the relationship between marketing activities, food culture, and health disparities? This commentary posits that food culture shapes the demand for food and the meaning attached to particular foods, preparation styles, and eating practices, while marketing activities shape the overall environment in which food choices are made. We build on prior research that explores the socio-cultural context in which marketing efforts are perceived and interpreted. We discuss each element of the marketing mix to highlight the complex relationship between food culture, marketing activities, and health disparities. Copyright © 2011 Elsevier Inc. All rights reserved.

Using social determinants of health to link health workforce diversity, care quality and access, and health disparities to achieve health equity in nursing.

Science.gov (United States)

Williams, Shanita D; Hansen, Kristen; Smithey, Marian; Burnley, Josepha; Koplitz, Michelle; Koyama, Kirk; Young, Janice; Bakos, Alexis

2014-01-01

It is widely accepted that diversifying the nation's health-care workforce is a necessary strategy to increase access to quality health care for all populations, reduce health disparities, and achieve health equity. In this article, we present a conceptual model that utilizes the social determinants of health framework to link nursing workforce diversity and care quality and access to two critical population health indicators-health disparities and health equity. Our proposed model suggests that a diverse nursing workforce can provide increased access to quality health care and health resources for all populations, and is a necessary precursor to reduce health disparities and achieve health equity. With this conceptual model as a foundation, we aim to stimulate the conceptual and analytical work-both within and outside the nursing field-that is necessary to answer these important but largely unanswered questions.

76 FR 21748 - Health Disparities Subcommittee (HDS), Advisory Committee to the Director, Centers for Disease...

Science.gov (United States)

2011-04-18

... Disparities Subcommittee (HDS), Advisory Committee to the Director, Centers for Disease Control and Prevention... through the ACD on strategic and other health disparities and health equity issues and provide guidance on... update including the CDC Health Disparities and Inequalities Report, U.S. 2011; the National Prevention...

What makes African American health disparities newsworthy? An experiment among journalists about story framing

Science.gov (United States)

Hinnant, Amanda; Oh, Hyun Jee; Caburnay, Charlene A.; Kreuter, Matthew W.

2011-01-01

News stories reporting race-specific health information commonly emphasize disparities between racial groups. But recent research suggests this focus on disparities has unintended effects on African American audiences, generating negative emotions and less interest in preventive behaviors (Nicholson RA, Kreuter MW, Lapka C et al. Unintended effects of emphasizing disparities in cancer communication to African-Americans. Cancer Epidemiol Biomarkers Prev 2008; 17: 2946–52). They found that black adults are more interested in cancer screening after reading about the progress African Americans have made in fighting cancer than after reading stories emphasizing disparities between blacks and whites. This study builds on past findings by (i) examining how health journalists judge the newsworthiness of stories that report race-specific health information by emphasizing disparities versus progress and (ii) determining whether these judgments can be changed by informing journalists of audience reactions to disparity versus progress framing. In a double-blind-randomized experiment, 175 health journalists read either a disparity- or progress-framed story on colon cancer, preceded by either an inoculation about audience effects of such framing or an unrelated (i.e. control) information stimuli. Journalists rated the disparity-frame story more favorably than the progress-frame story in every category of news values. However, the inoculation significantly increased positive reactions to the progress-frame story. Informing journalists of audience reactions to race-specific health information could influence how health news stories are framed. PMID:21911844

76 FR 55078 - National Center on Minority and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2011-09-06

... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel, ZMD1 RN (02) NIMHD Comprehensive Center of Excellence... Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892, (301) 496-3996, [email protected

Health disparities among health care workers.

Science.gov (United States)

Mawn, Barbara; Siqueira, Eduardo; Koren, Ainat; Slatin, Craig; Devereaux Melillo, Karen; Pearce, Carole; Hoff, Lee Ann

2010-01-01

In this article we describe the process of an interdisciplinary case study that examined the social contexts of occupational and general health disparities among health care workers in two sets of New England hospitals and nursing homes. A political economy of the work environment framework guided the study, which incorporated dimensions related to market dynamics, technology, and political and economic power. The purpose of this article is to relate the challenges encountered in occupational health care settings and how these could have impacted the study results. An innovative data collection matrix that guided small-group analysis provided a firm foundation from which to make design modifications to address these challenges. Implications for policy and research include the use of a political and economic framework from which to frame future studies, and the need to maintain rigor while allowing flexibility in design to adapt to challenges in the field.

Rural-Urban Disparities in Health and Health Care in Africa: Cultural ...

African Journals Online (AJOL)

Rural-Urban Disparities in Health and Health Care in Africa: Cultural Competence, Lay-beliefs in Narratives of Diabetes among the Rural Poor in the Eastern Cape ... to exist in the utilization of cardiac diagnostic and therapeutic procedures, prescription of analgesia for pains, treatment of diabetes (e.g. gym exercise).

Exploring the role of the dental hygienist in reducing oral health disparities in Canada: A qualitative study.

Science.gov (United States)

Farmer, J; Peressini, S; Lawrence, H P

2018-05-01

Reducing oral health disparities has been an ongoing challenge in Canada with the largest burden of oral disease exhibited in vulnerable populations, including Aboriginal people, the elderly, rural and remote residents, and newcomers. Dental hygienists are a unique set of professionals who work with and within communities, who have the potential to act as key change agents for improving the oral health of these populations. The purpose of this qualitative study was to explore, from the dental hygiene perspective, the role of dental hygienists in reducing oral health disparities in Canada. Dental hygienists and key informants in dental hygiene were recruited, using purposeful and theoretical sampling, to participate in a non-directed, semi-structured one-on-one in-depth telephone interview using Skype and Call Recorder software. Corbin and Strauss's grounded theory methodology was employed with open, axial, and selective coding analysed on N-Vivo Qualitative software. The resulting theoretical framework outlines strategies proposed by participants to address oral health disparities; these included alternate delivery models, interprofessional collaboration, and increased scope of practice. Participants identified variation in dental care across Canada, public perceptions of oral health and dental hygiene practice, and lack of applied research on effective oral health interventions as challenges to implementing these strategies. The research confirmed the important role played by dental hygienists in reducing oral health disparities in Canada. However, due to the fragmentation of dental hygiene practice across Canada, a unified voice and cohesive action plan is needed in order for the profession to fully embrace their role. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The Military Health Care System May Have the Potential to Prevent Health Care Disparities.

Science.gov (United States)

Pierre-Louis, Bosny J; Moore, Angelo D; Hamilton, Jill B

2015-09-01

The existence of health disparities in military populations has become an important topic of research. However, to our knowledge, this is the first study to examine health disparities, as related to access to care and health status, among active duty soldiers and their families. Specifically, the purpose of this analysis was to evaluate whether health disparities exist in access to care and health outcomes of patient satisfaction, physical health status, and mental health status according to race, gender, and sponsor rank in the population of active duty soldiers and their family members. In this cross-sectional study, active duty army soldiers and family members were recruited from either one particular army health clinic where they received their health care or from an adjacent shopping center frequented by eligible participants. Data were collected using validated measures to assess concepts of access to care and health status. Statistical analysis, including one-way analysis of variance (ANOVA) was performed to investigate differences in study outcome measures across four key demographic subgroups: race, gender, sponsor rank, and component (active soldier or family member). A total of 200 participants completed the study questionnaires. The sample consisted of 45.5 % soldiers and 54.5 % family members, with 88.5 % reporting a sponsor rank in the category of junior or senior enlisted rank. Mean scores for access to care did not differ significantly for the groups race/ethnicity (p = 0.53), gender (p = 0.14), and sponsor rank (p = 0.10). Furthermore, no significant differences were observed whether respondents were active soldiers or their family members (p = 0.36). Similarly, there were no statistically significant subgroup (race/ethnicity, gender, sponsor rank, or component) differences in mean patient satisfaction, physical health, and mental health scores. In a health equity system of care such as the military health care system, active duty

76 FR 57068 - National Center on Minority and Health Disparities Notice of Closed Meeting

Science.gov (United States)

2011-09-15

... and Health Disparities Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; ZMD1 RN 01 NIMHD Exploratory Centers of Excellence (P20... Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892, (301) 496-3996, [email protected

Defining and targeting health disparities in chronic obstructive pulmonary disease

Directory of Open Access Journals (Sweden)

Pleasants RA

2016-10-01

Full Text Available Roy A Pleasants,1–3 Isaretta L Riley,1–3 David M Mannino4 1Duke Asthma, Allergy, and Airways Center, 2Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, 3Durham VA Medical Center, Durham, NC, 4Division of Pulmonary, Critical Care, and Sleep Medicine, Pulmonary Epidemiology Research Laboratory, University of Kentucky, Lexington, KY, USA Abstract: The global burden of chronic obstructive pulmonary disease (COPD continues to grow in part due to better outcomes in other major diseases and in part because a substantial portion of the worldwide population continues to be exposed to inhalant toxins. However, a disproportionate burden of COPD occurs in people of low socioeconomic status (SES due to differences in health behaviors, sociopolitical factors, and social and structural environmental exposures. Tobacco use, occupations with exposure to inhalant toxins, and indoor biomass fuel (BF exposure are more common in low SES populations. Not only does SES affect the risk of developing COPD and etiologies, it is also associated with worsened COPD health outcomes. Effective interventions in these people are needed to decrease these disparities. Efforts that may help lessen these health inequities in low SES include 1 better surveillance targeting diagnosed and undiagnosed COPD in disadvantaged people, 2 educating the public and those involved in health care provision about the disease, 3 improving access to cost-effective and affordable health care, and 4 markedly increasing the efforts to prevent disease through smoking cessation, minimizing use and exposure to BF, and decreasing occupational exposures. COPD is considered to be one the most preventable major causes of death from a chronic disease in the world; therefore, effective interventions could have a major impact on reducing the global burden of the disease, especially in socioeconomically disadvantaged populations. Keywords: health disparities

76 FR 11499 - National Center on Minority and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2011-03-02

... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; 2011 LRP Panel 1. Date: March 18, 2011. Time: 8 a.m. to... Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892, (301) 451-9536, [email protected

76 FR 14673 - National Center on Minority and Health Disparities; Notice of Closed Meeting

Science.gov (United States)

2011-03-17

... and Health Disparities; Notice of Closed Meeting Pursuant to section 10(d) of the Federal Advisory... and Health Disparities Special Emphasis Panel; 2011 LRP Panel 3. Date: April 13, 2011. Time: 8 a.m. to... Disparities, 6707 Democracy Boulevard, Suite 800, Bethesda, MD 20892, (301) 451-9536, [email protected

A spatial national health facility database for public health sector planning in Kenya in 2008

Directory of Open Access Journals (Sweden)

Gething Peter W

2009-03-01

Full Text Available Abstract Background Efforts to tackle the enormous burden of ill-health in low-income countries are hampered by weak health information infrastructures that do not support appropriate planning and resource allocation. For health information systems to function well, a reliable inventory of health service providers is critical. The spatial referencing of service providers to allow their representation in a geographic information system is vital if the full planning potential of such data is to be realized. Methods A disparate series of contemporary lists of health service providers were used to update a public health facility database of Kenya last compiled in 2003. These new lists were derived primarily through the national distribution of antimalarial and antiretroviral commodities since 2006. A combination of methods, including global positioning systems, was used to map service providers. These spatially-referenced data were combined with high-resolution population maps to analyze disparity in geographic access to public health care. Findings The updated 2008 database contained 5,334 public health facilities (67% ministry of health; 28% mission and nongovernmental organizations; 2% local authorities; and 3% employers and other ministries. This represented an overall increase of 1,862 facilities compared to 2003. Most of the additional facilities belonged to the ministry of health (79% and the majority were dispensaries (91%. 93% of the health facilities were spatially referenced, 38% using global positioning systems compared to 21% in 2003. 89% of the population was within 5 km Euclidean distance to a public health facility in 2008 compared to 71% in 2003. Over 80% of the population outside 5 km of public health service providers was in the sparsely settled pastoralist areas of the country. Conclusion We have shown that, with concerted effort, a relatively complete inventory of mapped health services is possible with enormous potential for

A spatial national health facility database for public health sector planning in Kenya in 2008.

Science.gov (United States)

Noor, Abdisalan M; Alegana, Victor A; Gething, Peter W; Snow, Robert W

2009-03-06

Efforts to tackle the enormous burden of ill-health in low-income countries are hampered by weak health information infrastructures that do not support appropriate planning and resource allocation. For health information systems to function well, a reliable inventory of health service providers is critical. The spatial referencing of service providers to allow their representation in a geographic information system is vital if the full planning potential of such data is to be realized. A disparate series of contemporary lists of health service providers were used to update a public health facility database of Kenya last compiled in 2003. These new lists were derived primarily through the national distribution of antimalarial and antiretroviral commodities since 2006. A combination of methods, including global positioning systems, was used to map service providers. These spatially-referenced data were combined with high-resolution population maps to analyze disparity in geographic access to public health care. The updated 2008 database contained 5,334 public health facilities (67% ministry of health; 28% mission and nongovernmental organizations; 2% local authorities; and 3% employers and other ministries). This represented an overall increase of 1,862 facilities compared to 2003. Most of the additional facilities belonged to the ministry of health (79%) and the majority were dispensaries (91%). 93% of the health facilities were spatially referenced, 38% using global positioning systems compared to 21% in 2003. 89% of the population was within 5 km Euclidean distance to a public health facility in 2008 compared to 71% in 2003. Over 80% of the population outside 5 km of public health service providers was in the sparsely settled pastoralist areas of the country. We have shown that, with concerted effort, a relatively complete inventory of mapped health services is possible with enormous potential for improving planning. Expansion in public health care in Kenya has

Neighborhood Environment and Disparities in Health Care Access Among Urban Medicare Beneficiaries With Diabetes: A Retrospective Cohort Study.

Science.gov (United States)

Ryvicker, Miriam; Sridharan, Sridevi

2018-01-01

Older adults' health is sensitive to variations in neighborhood environment, yet few studies have examined how neighborhood factors influence their health care access. This study examined whether neighborhood environmental factors help to explain racial and socioeconomic disparities in health care access and outcomes among urban older adults with diabetes. Data from 123 233 diabetic Medicare beneficiaries aged 65 years and older in New York City were geocoded to measures of neighborhood walkability, public transit access, and primary care supply. In 2008, 6.4% had no office-based "evaluation and management" (E&M) visits. Multilevel logistic regression indicated that this group had greater odds of preventable hospitalization in 2009 (odds ratio = 1.31; 95% confidence interval: 1.22-1.40). Nonwhites and low-income individuals had greater odds of a lapse in E&M visits and of preventable hospitalization. Neighborhood factors did not help to explain these disparities. Further research is needed on the mechanisms underlying these disparities and older adults' ability to navigate health care. Even in an insured population living in a provider-dense city, targeted interventions may be needed to overcome barriers to chronic illness care for older adults in the community.

Bridging the digital divide in health care: the role of health information technology in addressing racial and ethnic disparities.

Science.gov (United States)

López, Lenny; Green, Alexander R; Tan-McGrory, Aswita; King, Roderick; Betancourt, Joseph R

2011-10-01

Racial and ethnic disparities in health care have been consistently documented in the diagnosis, treatment, and outcomes of many common clinical conditions. There has been an acceleration of health information technology (HIT) implementation in the United States, with health care reform legislation including multiple provisions for collecting and using health information to improve and monitor quality and efficiency in health care. Despite an uneven and generally low level of implementation, research has demonstrated that HIT has the potential to improve quality of care and patient safety. If carefully designed and implemented, HIT also has the potential to eliminate disparities. Several root causes for disparities are amenable to interventions using HIT, particularly innovations in electronic health records, as well as strategies for chronic disease management. Recommendations regardinghealth care system, provider, and patient factors can help health care organizations address disparities as they adopt, expand, and tailor their HIT systems. In terms of health care system factors, organizations should (1) automate and standardize the collection of race/ethnicity and language data, (2) prioritize the use of the data for identifying disparities and tailoring improvement efforts, (3) focus HIT efforts to address fragmented care delivery for racial/ethnic minorities and limited-English-proficiency patients, (4) develop focused computerized clinical decision support systems for clinical areas with significant disparities, and (5) include input from racial/ethnic minorities and those with limited English proficiency in developing patient HIT tools to address the digital divide. As investments are made in HIT, consideration must be given to the impact that these innovations have on the quality and cost of health care for all patients, including those who experience disparities.

Development and Dissemination of the El Centro Health Disparities Measures Library.

Science.gov (United States)

Mitrani, Victoria Behar; O'Day, Joanne E; Norris, Timothy B; Adebayo, Oluwamuyiwa Winifred

2017-09-01

This report describes the development and dissemination of a library of English measures, with Spanish translations, on constructs relevant to social determinants of health and behavioral health outcomes. The El Centro Measures Library is a product of the Center of Excellence for Health Disparities Research: El Centro, a program funded by the National Institute on Minority Health and Health Disparities of the U.S. National Institutes of Health. The library is aimed at enhancing capacity for minority health and health disparities research, particularly for Hispanics living in the United States and abroad. The open-access library of measures (available through www.miami.edu/sonhs/measureslibrary) contains brief descriptions of each measure, scoring information (where available), links to related peer-reviewed articles, and measure items in both languages. Links to measure websites where commercially available measures can be purchased are included, as is contact information for measures that require author permission. Links to several other measures libraries are hosted on the library website. Other researchers may contribute to the library. El Centro investigators began the library by electing to use a common set of measures across studies to assess demographic information, culture-related variables, proximal outcomes of interest, and major outcomes. The collection was expanded to include other health disparity research studies. In 2012, a formal process was developed to organize, expand, and centralize the library in preparation for a gradual process of dissemination to the national and international community of researchers. The library currently contains 61 measures encompassing 12 categories of constructs. Thus far, the library has been accessed 8,883 times (unique page views as generated by Google Analytics), and responses from constituencies of users and measure authors have been favorable. With the paucity of availability and accessibility of translated

Reducing Cancer Health Disparities through Community Engagement: Working with Faith-Based Organizations (Project CHURCH)

Science.gov (United States)

Lorna H. McNeill, PhD, MPH, is Chair and Associate Professor in the Department of Health Disparities at the University of Texas MD Anderson Cancer Center. Dr. McNeill's research is on the elimination of cancer-related health disparities in minority populations. Her research has particular emphasis on understanding the influence of social contextual determinants of cancer in minorities, with a special focus of the role of physical activity as a key preventive behavior and obesity as a major cancer determinant. Her research takes place in minority and underserved communities such as public housing developments, black churches, community-based clinics and low-income neighborhoods-communities with excess cancer death rates. She has been continuously funded, receiving grants from various funding agencies (i.e., National Institutes of Health, Robert Wood Johnson Foundation, etc.), to better understand and design innovative solutions to address obesity in racial/ethnic minority communities. Dr. McNeill is PI of several community-based studies, primarily working with African American churches. One is a called Project CHURCH, an academic-faith-based partnership established to: 1) identify underlying reasons for health disparities in cancer and cancer risk factors (e.g., screening, diet) among AAs using a cohort study (N=2400), 2) engage AAs as partners in the research process, and 3) to ultimately eliminate disparities among AAs. In 2014 Dr. McNeill furthered her partnership through the Faith, Health, and Family (FHF) Collaborative. The goals of FHF are to enhance the Project CHURCH partnership to address family obesity in African Americans, strengthen the partnership by developing a larger coalition of organizations and stakeholders to address the problem, assess church and community interest in family obesity and develop an agenda to address obesity in faith settings. To date we have 50 churches as members. Dr. McNeill is also director of the Center for Community

Sex and Race Disparities in Health: Cohort Variations in Life Course Patterns

Science.gov (United States)

Yang, Yang; Lee, Linda C.

2009-01-01

This study assesses changes in sex and race disparities in health over the life course and across cohorts by conducting growth curve analyses of nationally representative longitudinal data that spans 15 years. It finds that changes in disparities in depressive symptoms, disability and self-assessments of health across the life course are…

Vitamin D and Cardiovascular Disease: Potential Role in Health Disparities

Science.gov (United States)

Artaza, Jorge N.; Contreras, Sandra; Garcia, Leah A.; Mehrotra, Rajnish; Gibbons, Gary; Shohet, Ralph; Martins, David; Norris, Keith C.

2012-01-01

Cardiovascular disease (CVD), which includes coronary artery disease and stroke, is the leading cause of mortality in the nation. Excess CVD morbidity and premature mortality in the African American community is one of the most striking examples of racial/ethnic disparities in health outcomes. African Americans also suffer from increased rates of hypovitaminosis D, which has emerged as an independent risk factor for all-cause and cardiovascular mortality. This overview examines the potential role of hypovitaminosis D as a contributor to racial and ethnic disparities in cardiovascular disease (CVD). We review the epidemiology of vitamin D and CVD in African Americans and the emerging biological roles of vitamin D in key CVD signaling pathways that may contribute to the epidemiological findings and provide the foundation for future therapeutic strategies for reducing health disparities. PMID:22102304

Improving Service Coordination and Reducing Mental Health Disparities Through Adoption of Electronic Health Records.

Science.gov (United States)

McGregor, Brian; Mack, Dominic; Wrenn, Glenda; Shim, Ruth S; Holden, Kisha; Satcher, David

2015-09-01

Despite widespread support for removing barriers to the use of electronic health records (EHRs) in behavioral health care, adoption of EHRs in behavioral health settings lags behind adoption in other areas of health care. The authors discuss barriers to use of EHRs among behavioral health care practitioners, suggest solutions to overcome these barriers, and describe the potential benefits of EHRs to reduce behavioral health care disparities. Thoughtful and comprehensive strategies will be needed to design EHR systems that address concerns about policy, practice, costs, and stigma and that protect patients' privacy and confidentiality. However, these goals must not detract from continuing to challenge the notion that behavioral health and general medical health should be treated as separate and distinct. Ultimately, utilization of EHRs among behavioral health care providers will improve the coordination of services and overall patient care, which is essential to reducing mental health disparities.

Hospital Adoption of Health Information Technology to Support Public Health Infrastructure.

Science.gov (United States)

Walker, Daniel M; Diana, Mark L

2016-01-01

significant room for growth. Differences in hospitals' adoption of public health IT may exacerbate existing health disparities.

Disparities in Care for Publicly Insured Women With Pregestational Diabetes.

Science.gov (United States)

Easter, Sarah Rae; Rosenthal, Emily W; Morton-Eggleston, Emma; Nour, Nawal; Tuomala, Ruth; Zera, Chloe A

2017-11-01

To investigate the association among public health insurance, preconception care, and pregnancy outcomes in pregnant women with pregestational diabetes. This is a retrospective cohort of pregnant women with pregestational type 1 or type 2 diabetes from 2006 to 2011 in Massachusetts-a state with universal insurance coverage since 2006. Women delivering after 24 weeks of gestation and receiving endocrinology and obstetric care in a multidisciplinary clinic were included. Rates of preconception consultation, our primary outcome of interest, were then compared between publicly and privately insured women. We used univariate analysis followed by logistic regression to compare receipt of preconception consultation and other secondary diabetes care measures and pregnancy outcomes according to insurance status. Fifty-four percent (n=106) of 197 women had public insurance. Publicly insured women were younger (median age 30.4 compared with 35.3 years, P<.01) with lower rates of college education (12.3% compared with 45.1%, P<.01). Women with public insurance were less likely to receive a preconception consult (5.7% compared with 31.9%, P<.01), had lower rates of hemoglobin A1C less than 6% at the onset of pregnancy (37.2% compared with 58.4%, P=.01), and experienced higher rates of pregnancies affected by congenital anomalies (10.4% compared with 2.2%, P=.02) compared with those with private insurance. In adjusted analyses controlling for educational attainment, maternal age, and body mass index, women with public insurance were less likely to receive a preconception consult (adjusted odds ratio [OR] 0.21, 95% CI 0.08-0.58), although the odds of achieving the target hemoglobin A1C (adjusted OR 0.45, 95% CI 0.20-1.02) and congenital anomaly (adjusted OR 2.23, 95% CI 0.37-13.41) were similar after adjustment. Despite continuous access to health insurance, publicly insured women were less likely than privately insured women to receive a preconception consult-an evidence

Educational Health Disparities in Cardiovascular Disease Risk Factors: Findings from Jamaica Health and Lifestyle Survey 2007–2008

Directory of Open Access Journals (Sweden)

Trevor S. Ferguson

2017-05-01

Full Text Available ObjectivesSocioeconomic disparities in health have emerged as an important area in public health, but studies from Afro-Caribbean populations are uncommon. In this study, we report on educational health disparities in cardiovascular disease (CVD risk factors (hypertension, diabetes mellitus, hypercholesterolemia, and obesity, among Jamaican adults.MethodsWe analyzed data from the Jamaica Health and Lifestyle Survey 2007–2008. Trained research staff administered questionnaires and obtained measurements of blood pressure, anthropometrics, glucose and cholesterol. CVD risk factors were defined by internationally accepted cut-points. Educational level was classified as primary or lower, junior secondary, full secondary, and post-secondary. Educational disparities were assessed using age-adjusted or age-specific prevalence ratios and prevalence differences obtained from Poisson regression models. Post-secondary education was used as the reference category for all comparisons. Analyses were weighted for complex survey design to yield nationally representative estimates.ResultsThe sample included 678 men and 1,553 women with mean age of 39.4 years. The effect of education on CVD risk factors differed between men and women and by age group among women. Age-adjusted prevalence of diabetes mellitus was higher among men with less education, with prevalence differences ranging from 6.9 to 7.4 percentage points (p < 0.05 for each group. Prevalence ratios for diabetes among men ranged from 3.3 to 3.5 but were not statistically significant. Age-specific prevalence of hypertension was generally higher among the less educated women, with statistically significant prevalence differences ranging from 6.0 to 45.6 percentage points and prevalence ratios ranging from 2.5 to 4.3. Similarly, estimates for obesity and hypercholesterolemia suggested that prevalence was higher among the less educated younger women (25–39 years and among more educated older

RACIAL DISPARITIES IN HEALTH

Science.gov (United States)

Sternthal, Michelle J.; Slopen, Natalie; Williams, David R.

2017-01-01

Despite the widespread assumption that racial differences in stress exist and that stress is a key mediator linking racial status to poor health, relatively few studies have explicitly examined this premise. We examine the distribution of stress across racial groups and the role of stress vulnerability and exposure in explaining racial differences in health in a community sample of Black, Hispanic, and White adults, employing a modeling strategy that accounts for the correlation between types of stressors and the accumulation of stressors in the prediction of health outcomes. We find significant racial differences in overall and cumulative exposure to eight stress domains. Blacks exhibit a higher prevalence and greater clustering of high stress scores than Whites. American-born Hispanics show prevalence rates and patterns of accumulation of stressors comparable to Blacks, while foreign-born Hispanics have stress profiles similar to Whites. Multiple stressors correlate with poor physical and mental health, with financial and relationship stressors exhibiting the largest and most consistent effects. Though we find no support for the stress-vulnerability hypothesis, the stress-exposure hypothesis does account for some racial health disparities. We discuss implications for future research and policy.

Income Disparities in the Use of Health Screening Services Among University Students in Korea

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Lee, Su Hyun; Joh, Hee-Kyung; Kim, Soojin; Oh, Seung-Won; Lee, Cheol Min; Kwon, Hyuktae

2016-01-01

Abstract Public health insurance coverage for preventive care in young adults is incomplete in Korea. Few studies have focused on young adults’ socioeconomic disparities in preventive care utilization. We aimed to explore household income disparities in the use of different types of health screening services among university students in Korea. This cross-sectional study used a web-based self-administered survey of students at a university in Korea from January to February 2013. To examine the associations between household income levels and health screening service use within the past 2 years, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression with adjustment for various covariables. Of 2479 participants, 45.5% reported using health screening services within 2 years (university-provided screening 32.9%, private sector screening 16.7%, and both 4.1%). Household income levels were not significantly associated with overall rates of health screening service use with a multivariable-adjusted OR (95% CI) in the lowest versus highest income group of 1.12 (0.87–1.45, Ptrend = 0.35). However, we found significantly different associations in specific types of utilized screening services by household income levels. The multivariable-adjusted OR (95% CI) of university-provided health screening service use in the lowest versus highest income level was 1.74 (1.30–2.34; Ptrend income level was 0.45 (0.31–0.66; Ptrend income groups among university students in Korea, although overall rates of health screening service use were similar across income levels. Low-income students were more likely to use university-provided health screening services, and less likely to use private sector screening services. To ensure appropriate preventive care delivery for young adults and to address disparities in disadvantaged groups, the expansion of medical insurance coverage for preventive health care, establishment of a usual source of

Distance decay and persistent health care disparities in South Africa.

Science.gov (United States)

McLaren, Zoë M; Ardington, Cally; Leibbrandt, Murray

2014-11-04

Access to health care is a particular concern given the important role of poor access in perpetuating poverty and inequality. South Africa's apartheid history leaves large racial disparities in access despite post-apartheid health policy to increase the number of health facilities, even in remote rural areas. However, even when health services are provided free of charge, monetary and time costs of travel to a local clinic may pose a significant barrier for vulnerable segments of the population, leading to overall poorer health. Using newly available health care utilization data from the first nationally representative panel survey in South Africa, together with administrative geographic data from the Department of Health, we use graphical and multivariate regression analysis to investigate the role of distance to the nearest facility on the likelihood of having a health consultation or an attended birth. Ninety percent of South Africans live within 7 km of the nearest public clinic, and two-thirds live less than 2 km away. However, 14% of Black African adults live more than 5 km from the nearest facility, compared to only 4% of Whites, and they are 16 percentage points less likely to report a recent health consultation (p apartheid but progress is still needed to achieve equity in health care access.

Psychiatrists' attitudes toward and awareness about racial disparities in mental health care.

Science.gov (United States)

Mallinger, Julie B; Lamberti, J Steven

2010-02-01

Psychiatrists may perpetuate racial-ethnic disparities in health care through racially biased, albeit unconscious, behaviors. Changing these behaviors requires that physicians accept that racial-ethnic disparities exist and accept their own contributions to disparities. The purposes of this study were to assess psychiatrists' awareness of racial disparities in mental health care, to evaluate the extent to which psychiatrists believe they contribute to disparities, and to determine psychiatrists' interest in participating in disparities-reduction programs. A random sample of psychiatrists, identified through the American Psychiatric Association's member directory, was invited to complete the online survey. The survey was also distributed to psychiatrists at a national professional conference. Of the 374 respondents, most said they were not familiar or only a little familiar with the literature on racial disparities. Respondents tended to believe that race has a moderate influence on quality of psychiatric care but that race is more influential in others' practices than in their own practices. One-fourth had participated in any type of disparities-reduction program within the past year, and approximately one-half were interested in participating in such a program. Psychiatrists may not recognize the pervasiveness of racial inequality in psychiatric care, and they may attribute racially biased thinking to others but not to themselves. Interventions to eliminate racial-ethnic disparities should focus on revealing and modifying unconscious biases. Lack of physician interest may be one barrier to such interventions.

Individual- and area-level disparities in access to the road network, subway system and a public bicycle share program on the Island of Montreal, Canada.

Science.gov (United States)

Fuller, Daniel; Gauvin, Lise; Kestens, Yan

2013-02-01

Few studies have examined potential disparities in access to transportation infrastructures, an important determinant of population health. To examine individual- and area-level disparities in access to the road network, public transportation system, and a public bicycle share program in Montreal, Canada. Examining associations between sociodemographic variables and access to the road network, public transportation system, and a public bicycle share program, 6,495 adult respondents (mean age, 48.7 years; 59.0 % female) nested in 33 areas were included in a multilevel analysis. Individuals with lower incomes lived significantly closer to public transportation and the bicycle share program. At the area level, the interaction between low-education and low-income neighborhoods showed that these areas were significantly closer to public transportation and the bicycle share program controlling for individual and urbanicity variables. More deprived areas of the Island of Montreal have better access to transportation infrastructure than less-deprived areas.

Influence of Hormonal Contraceptive Use and Health Beliefs on Sexual Orientation Disparities in Papanicolaou Test Use

Science.gov (United States)

Corliss, Heather L.; Missmer, Stacey A.; Frazier, A. Lindsay; Rosario, Margaret; Kahn, Jessica A.; Austin, S. Bryn

2014-01-01

Objectives. Reproductive health screenings are a necessary part of quality health care. However, sexual minorities underutilize Papanicolaou (Pap) tests more than heterosexuals do, and the reasons are not known. Our objective was to examine if less hormonal contraceptive use or less positive health beliefs about Pap tests explain sexual orientation disparities in Pap test intention and utilization. Methods. We used multivariable regression with prospective data gathered from 3821 females aged 18 to 25 years in the Growing Up Today Study (GUTS). Results. Among lesbians, less hormonal contraceptive use explained 8.6% of the disparities in Pap test intention and 36.1% of the disparities in Pap test utilization. Less positive health beliefs associated with Pap testing explained 19.1% of the disparities in Pap test intention. Together, less hormonal contraceptive use and less positive health beliefs explained 29.3% of the disparities in Pap test intention and 42.2% of the disparities in Pap test utilization. Conclusions. Hormonal contraceptive use and health beliefs, to a lesser extent, help to explain sexual orientation disparities in intention and receipt of a Pap test, especially among lesbians. PMID:23763393

Moving beyond the trickle-down approach: addressing the unique disparate health experiences of adolescents of color.

Science.gov (United States)

Guthrie, Barbara J; Low, Lisa Kane

2006-01-01

Health disparities in adults have received significant attention and research, yet the healthcare experiences of adolescents of color have been ignored. The purpose of this paper is to identify the shortcomings of our state of knowledge regarding adolescent health disparities and argue for the use of an inter-sectional, contextually embedded understanding of healthcare experiences. To understand health disparities, deficit-based models should be replaced with the framework proposed in this paper. Using the proposed model in practice will aid in identifying and preventing the health disparities experienced by adolescents of color.

Race, Racism, and Health Disparities: What Can I Do About It?

Science.gov (United States)

Nelson, Stephen

2016-08-01

Disparities based on race that target communities of color are consistently reported in the management of many diseases. Barriers to health care equity include the health care system, the patient, the community, and health care providers. This article focuses on the health care system as well as health care providers and how racism and our implicit biases affect our medical decision making. Health care providers receive little or no training on issues of race and racism. As a result, awareness of racism and its impact on health care delivery is low. I will discuss a training module that helps improve awareness around these issues. Until racial issues are honestly addressed by members of the health care team, it is unlikely that we will see significant improvements in racial health care disparities for Americans.

Infant mortality: a call to action overcoming health disparities in the United States

Directory of Open Access Journals (Sweden)

Allison A. Vanderbilt

2013-09-01

Full Text Available Among all of the industrialized countries, the United States has the highest infant mortality rate. Racial and ethnic disparities continue to plague the United States with a disproportionally high rate of infant death. Furthermore, racial disparities among infant and neonatal mortality rates remain a chronic health problem in the United States. These risks are based on the geographical variations in mortality and disparities among differences in maternal risk characteristics, low birth weights, and lack of access to health care.

Disparities in chronic conditions and health status by type of disability.

Science.gov (United States)

Horner-Johnson, Willi; Dobbertin, Konrad; Lee, Jae Chul; Andresen, Elena M

2013-10-01

Prior research has established health disparities between people with and without disabilities. However, disparities within the disability population, such as those related to type of disability, have been much less studied. To examine differences in chronic conditions and health status between subgroups of people with different types of disability. We analyzed Medical Expenditure Panel Survey annual data files from 2002 to 2008. Logistic regression analyses considered disparity from three perspectives: 1) basic differences, unadjusted for other factors; 2) controlling for key demographic and health covariates; and 3) controlling for a larger set of demographic variables and socioeconomic status as well as health and access to healthcare. Individuals with vision, physical, cognitive, or multiple disability types fared worse than people with hearing impairment on most health outcomes. This was most consistently true for people with multiple disabilities. Even when all covariates were accounted for, people with multiple types of disability were significantly more likely (p disability types were reduced when controlling for other factors, some differences remained significant. This argues for a more individualized approach to understanding and preventing chronic conditions and poor health in specific disability groups. Copyright © 2013 Elsevier Inc. All rights reserved.

Implications of sleep and energy drink use for health disparities

Science.gov (United States)

Grandner, Michael A; Knutson, Kristen L; Troxel, Wendy; Hale, Lauren; Jean-Louis, Girardin; Miller, Kathleen E

2014-01-01

The popularity of energy drinks has increased rapidly in the past decade. One of the main reasons people use energy drinks is to counteract effects of insufficient sleep or sleepiness. Risks associated with energy drink use, including those related to sleep loss, may be disproportionately borne by racial minorities and those of lower socioeconomic status. In this review, a brief introduction to the issue of health disparities is provided, population-level disparities and inequalities in sleep are described, and the social-ecological model of sleep and health is presented. Social and demographic patterns of energy drink use are then presented, followed by discussion of the potential ways in which energy drink use may contribute to health disparities, including the following: 1) effects of excessive caffeine in energy drinks, 2) effects of energy drinks as sugar-sweetened beverages, 3) association between energy drinks and risk-taking behaviors when mixed with alcohol, 4) association between energy drink use and short sleep duration, and 5) role of energy drinks in cardiometabolic disease. The review concludes with a research agenda of critical unanswered questions. PMID:25293540

How Resource Dynamics Explain Accumulating Developmental and Health Disparities for Teen Parents’ Children

Science.gov (United States)

Mollborn, Stefanie; Lawrence, Elizabeth; James-Hawkins, Laurie; Fomby, Paula

2014-01-01

This study examines the puzzle of disparities experienced by U.S. teen parents’ young children, whose health and development increasingly lag behind those of peers while their parents are simultaneously experiencing socioeconomic improvements. Using the nationally representative Early Childhood Longitudinal Study-Birth Cohort (2001–2007; N ≈ 8,600), we assess four dynamic patterns in socioeconomic resources that might account for these growing developmental and health disparities throughout early childhood and then test them in multilevel growth curve models. Persistently low socioeconomic resources constituted the strongest explanation, given that consistently low income, maternal education, and assets fully or partially account for growth in cognitive, behavioral, and health disparities experienced by teen parents’ children from infancy through kindergarten. That is, although teen parents gained socioeconomic resources over time, those resources remained relatively low, and the duration of exposure to limited resources explains observed growing disparities. Results suggest that policy interventions addressing the time dynamics of low socioeconomic resources in a household, in terms of both duration and developmental timing, are promising for reducing disparities experienced by teen parents’ children. PMID:24802282

Commentary: getting real on addressing health care disparities and other systems problems.

Science.gov (United States)

Madara, James L

2012-06-01

Physician membership organizations vary in the extent of their engagement in activities to address health disparities. Increasing engagement of those organizations not already highly active in this critical area is, thus, an opportunity. Studies that provide definitional contours of key issues, like disparities, are necessary and must be iteratively refined. However, parallel activities of intervention with measured outcomes to assess the effects of these interventions are necessary to truly address major problems in the health care system. To date, work in the problem definition category exceeds work toward intervention in and mitigation of these problems with measured outcomes. Many problems in health care, including disparities, are now sufficiently understood that it is time to shift focus toward bold intervention with measured outcomes. Optimal approaches that yield superior outcomes generally require collaboration across the provider-payer spectrum and the private sectors, including physicians, hospitals, insurers, etc. Stakeholders are now free to act in such coordinated fashion; it only requires social capital that permits cooperation and compromise. Interventions for problems such as health care disparities can be developed in the private sector and mirrored by government payers if physicians and organizations can get real about collaborating to implement outcomes-based initiatives to improve the health of all patients.

Rural-Urban Disparities in Health and Health Care in Africa: Cultural ...

African Journals Online (AJOL)

medical health care system, rural-urban disparities would seem obvious. .... have led to the development and onset of the illness and cure/controllability, what the ..... and then went back for the result but the nurse that I saw said that I should ...

The Role of Data in Health Care Disparities in Medicaid...

Data.gov (United States)

U.S. Department of Health & Human Services — According to findings reported in The Role of Data in Health Care Disparities in Medicaid Managed Care, published in Volume 2, Issue 4 of the Medicare and Medicaid...

Racial disparities in smoking knowledge among current smokers: data from the health information national trends surveys.

Science.gov (United States)

Reimer, Rachel Ann; Gerrard, Meg; Gibbons, Frederick X

2010-10-01

Although African-Americans (Blacks) smoke fewer cigarettes per day than European-Americans (Whites), there is ample evidence that Blacks are more susceptible to smoking-related health consequences. A variety of behavioural, social and biological factors have been linked to this increased risk. There has been little research, however, on racial differences in smoking-related knowledge and perceived risk of lung cancer. The primary goal of the current study was to evaluate beliefs and knowledge that contribute to race disparities in lung cancer risk among current smokers. Data from two separate nationally representative surveys (the Health Information National Trends surveys 2003 and 2005) were analysed. Logistic and hierarchical regressions were conducted; gender, age, education level, annual household income and amount of smoking were included as covariates. In both studies, Black smokers were significantly more likely to endorse inaccurate statements than were White smokers, and did not estimate their lung cancer risk to be significantly higher than Whites. Results highlight an important racial disparity in public health knowledge among current smokers.

Illuminating cancer health disparities using ethnogenetic layering (EL) and phenotype segregation network analysis (PSNA).

Science.gov (United States)

Jackson, Fatimah L C

2006-01-01

Resolving cancer health disparities continues to befuddle simplistic racial models. The racial groups alluded to in biomedicine, public health, and epidemiology are often profoundly substructured. EL and PSNA are computational assisted techniques that focus on microethnic group (MEG) substructure. Geographical variations in cancer may be due to differences in MEG ancestry or similar environmental exposures to a recognized carcinogen. Examples include breast and prostate cancers in the Chesapeake Bay region and Bight of Biafra biological ancestry, hypertension and stroke in the Carolina Coast region and Central African biological ancestry, and pancreatic cancer in the Mississippi Delta region and dietary/medicinal exposure to safrol from Sassafras albidum.

Preventing Filipino Mental Health Disparities: Perspectives from Adolescents, Caregivers, Providers, and Advocates.

Science.gov (United States)

Javier, Joyce R; Supan, Jocelyn; Lansang, Anjelica; Beyer, William; Kubicek, Katrina; Palinkas, Lawrence A

2014-12-01

Filipino Americans are the second largest immigrant population and second largest Asian ethnic group in the U.S. Disparities in youth behavioral health problems and the receipt of mental health services among Filipino youth have been documented previously. However, few studies have elicited perspectives from community stakeholders regarding how to prevent mental health disparities among Filipino youth. The purpose of the current study is to identify intervention strategies for implementing mental health prevention programs among Filipino youth. We conducted semi-structured interviews (n=33) with adolescents, caregivers, advocates, and providers and focus groups (n=18) with adolescents and caregivers. Interviews were audio taped and transcribed verbatim. Transcripts were analyzed using a methodology of "coding consensus, co-occurrence, and comparison" and was rooted in grounded theory. Four recommendations were identified when developing mental health prevention strategies among Filipino populations: address the intergenerational gap between Filipino parents and children, provide evidence-based parenting programs, collaborate with churches in order to overcome stigma associated with mental health, and address mental health needs of parents. Findings highlight the implementation of evidence-based preventive parenting programs in faith settings as a community-identified and culturally appropriate strategy to prevent Filipino youth behavioral health disparities.

Factors influencing the effectiveness of interventions to reduce racial and ethnic disparities in health care.

Science.gov (United States)

Jones, Rhys G; Trivedi, Amal N; Ayanian, John Z

2010-02-01

Reducing racial and ethnic disparities in health care has become an important policy goal in the United States and other countries, but evidence to inform interventions to address disparities is limited. The objective of this study was to identify important dimensions of interventions to reduce health care disparities. We used qualitative research methods to examine interventions aimed at improving diabetes and/or cardiovascular care for patients from racial and ethnic minority groups within five health care organizations. We interviewed 36 key informants and conducted a thematic analysis to identify important features of these interventions. Key elements of interventions included two contextual factors (external accountability and alignment of incentives to reduce disparities) and four factors related to the organization or intervention itself (organizational commitment, population health focus, use of data to inform solutions, and a comprehensive approach to quality). Consideration of these elements could improve the design, implementation, and evaluation of future interventions to address racial and ethnic disparities in health care. Copyright 2009 Elsevier Ltd. All rights reserved.

Urban-rural disparities in child nutrition-related health outcomes in China: The role of hukou policy.

Science.gov (United States)

Liu, Hong; Rizzo, John A; Fang, Hai

2015-11-23

Hukou is the household registration system in China that determines eligibility for various welfare benefits, such as health care, education, housing, and employment. The hukou system may lead to nutritional and health disparities in China. We aim at examining the role of the hukou system in affecting urban-rural disparities in child nutrition, and disentangling the institutional effect of hukou from the effect of urban/rural residence on child nutrition-related health outcomes. This study uses data from the China Health and Nutrition Survey 1993-2009 with a sample of 9616 children under the age of 18. We compute height-for-age z-score and weight-for-age z-score for children. We use both descriptive statistics and multiple regression techniques to study the levels and significance of the association between child nutrition-related health outcomes and hukou type. Children with urban hukou have 0.25 (P system exacerbates urban-rural disparities in child nutrition-related health outcomes independent of the well-known disparity stemming from urban-rural residence. Fortunately, however, child health disparities due to hukou have been declining since 2000.

Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities.

Science.gov (United States)

Chapman, Elizabeth N; Kaatz, Anna; Carnes, Molly

2013-11-01

Although the medical profession strives for equal treatment of all patients, disparities in health care are prevalent. Cultural stereotypes may not be consciously endorsed, but their mere existence influences how information about an individual is processed and leads to unintended biases in decision-making, so called "implicit bias". All of society is susceptible to these biases, including physicians. Research suggests that implicit bias may contribute to health care disparities by shaping physician behavior and producing differences in medical treatment along the lines of race, ethnicity, gender or other characteristics. We review the origins of implicit bias, cite research documenting the existence of implicit bias among physicians, and describe studies that demonstrate implicit bias in clinical decision-making. We then present the bias-reducing strategies of consciously taking patients' perspectives and intentionally focusing on individual patients' information apart from their social group. We conclude that the contribution of implicit bias to health care disparities could decrease if all physicians acknowledged their susceptibility to it, and deliberately practiced perspective-taking and individuation when providing patient care. We further conclude that increasing the number of African American/Black physicians could reduce the impact of implicit bias on health care disparities because they exhibit significantly less implicit race bias.

Applying Organizational Change to Promote Lesbian, Gay, Bisexual, and Transgender Inclusion and Reduce Health Disparities.

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Eckstrand, Kristen L; Lunn, Mitchell R; Yehia, Baligh R

2017-06-01

Lesbian, gay, bisexual, and transgender (LGBT) populations face numerous barriers when accessing and receiving healthcare, which amplify specific LGBT health disparities. An effective strategic approach is necessary for academic health centers to meet the growing needs of LGBT populations. Although effective organizational change models have been proposed for other minority populations, the authors are not aware of any organizational change models that specifically promote LGBT inclusion and mitigate access barriers to reduce LGBT health disparities. With decades of combined experience, we identify elements and processes necessary to accelerate LGBT organizational change and reduce LGBT health disparities. This framework may assist health organizations in initiating and sustaining meaningful organizational change to improve the health and healthcare of the LGBT communities.

Special Issue on Global Health Disparities Focus on Cancer.

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Lee, Haeok

2016-01-01

Haeok Lee, PhD, RN, FAAN who is a Korean-American nurse scientist, received her doctor al degree from the Nursing Physiology Department, College of Nursing, University of California, San Francisco (UCSF), in 1993, and her post doctor al training from College of Medicine, UCSF. Dr. Lee worked at Case Western Reserve University and University of Colorado Health Sciences Center. She has worked at the UMass Boston since 2008. Dr. Lee has established a long-term commitment to minority health, especially Asian American Pacific Islanders, as a community leader, community health educator, and community researcher, and all these services have become a foundation for her community-based participatory research. Dr. Lee's research addresses current health problems framed in the context of social, political, and economic settings, and her studies have improved racial and ethnic data and developed national health policies to address health disparities in hepatitis B virus (HBV) infections and liver cancer among minorities. Dr. Lee's research, which is noteworthy for its theoretical base, is clearly filling the gap. Especially, Dr. Lee's research is beginning to have a favorable impact on national and international health policies and continuing education programs directed toward the global elimination of cervical and liver cancer-related health disparities in underserved and understudied populations.

Personal vis-a-vis social responsibility for disparities in health status: An issue of justice.

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Jha, Ayan; Dobe, Madhumita

2016-01-01

Health inequities are disparities which can be avoided through rational actions on the part of policymakers. Such inequalities are unnecessary and unjust and may exist between and within nations, societies, and population groups. Social determinants such as wealth, income, occupation, education, gender, and racial/ethnic groups are the principal drivers of this inequality since they determine the health risks and preventive behaviors, access to, and affordability of health care. Within this framework, there is a debate on assigning a personal responsibility factor over and above societal responsibility to issues of ill health. One school of philosophy argues that when individuals are worse-off than others for no fault of their own, it is unjust, as opposed to health disparities that arise due to avoidable personal choices such as smoking and drug addiction for which there should (can) be a personal responsibility. Opposing thoughts have pointed out that the relative socioeconomic position of an individual dictates how his/her life may progress from education to working conditions and aging, susceptibility to diseases and infirmity, and the consequences thereof. The existence of a social gradient in health outcomes across populations throughout the world is a testimony to this truth. It has been emphasized that assuming personal responsibility for health in public policy-making can only have a peripheral place. Instead, the concept of individual responsibility should be promoted as a positive concept of enabling people to gain control over the determinants of health through conscious, informed, and healthy choices.

Visualizing value for money in public health interventions.

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Leigh-Hunt, Nicholas; Cooper, Duncan; Furber, Andrew; Bevan, Gwyn; Gray, Muir

2018-01-23

The Socio-Technical Allocation of Resources (STAR) has been developed for value for money analysis of health services through stakeholder workshops. This article reports on its application for prioritization of interventions within public health programmes. The STAR tool was used by identifying costs and service activity for interventions within commissioned public health programmes, with benefits estimated from the literature on economic evaluations in terms of costs per Quality-Adjusted Life Years (QALYs); consensus on how these QALY values applied to local services was obtained with local commissioners. Local cost-effectiveness estimates could be made for some interventions. Methodological issues arose from gaps in the evidence base for other interventions, inability to closely match some performance monitoring data with interventions, and disparate time horizons of published QALY data. Practical adjustment for these issues included using population prevalences and utility states where intervention specific evidence was lacking, and subdivision of large contracts into specific intervention costs using staffing ratios. The STAR approach proved useful in informing commissioning decisions and understanding the relative value of local public health interventions. Further work is needed to improve robustness of the process and develop a visualization tool for use by public health departments. © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Stigmatized biologies: Examining the cumulative effects of oral health disparities for Mexican American farmworker children.

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Horton, Sarah; Barker, Judith C

2010-06-01

Severe early childhood caries (ECC) can leave lasting effects on children's physical development, including malformed oral arches and crooked permanent dentition. This article examines the way that the ECC of Mexican American farmworker children in the United States sets them up for lasting dental problems and social stigma as young adults. We examine the role of dietary and environmental factors in contributing to what we call "stigmatized biologies," and that of market-based dental public health insurance systems in cementing their enduring effects. We adapt Margaret Lock's term, local biology, to illustrate the way that biology differs not only because of culture, diet, and environment but also because of disparities in insurance coverage. By showing the long-term effects of ECC and disparate dental treatment on farmworker adults, we show how the interaction of immigrant caregiving practices and underinsurance can having lasting social effects. An examination of the long-term effects of farmworker children's ECC illustrates the ways that market-based health care systems can create embodied differences that in turn reproduce a system of social inequality.

Asthma and Health Disparities | NIH MedlinePlus the Magazine

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... page please turn Javascript on. Feature: Breathing Easier Asthma and Health Disparities Past Issues / Fall 2013 Table ... under 18 years of age, who currently have asthma, 2010 Non-Hispanic Black Non-Hispanic White Non- ...

Disparities in the Use of Preventive Health Care among Children with Disabilities in Taiwan

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Tsai, Wen-Chen; Kung, Pei-Tseng; Wang, Jong-Yi

2012-01-01

Children with disabilities face more barriers accessing preventive health services. Prior research has documented disparities in the receipt of these services. However, most are limited to specific types of disability or care. This study investigates disparities in the use of preventive health care among children with disabilities in Taiwan. Three…

Health journalism internships: a social marketing strategy to address health disparities.

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Nguyen, Duy H; Shimasaki, Suzuho; Stafford, Helen Shi; Sadler, Georgia Robins

2010-09-01

The USA seeks to eliminate health disparities by stimulating the rapid uptake of health-promoting behaviors within disadvantaged communities. A health journalism internship incorporates social marketing strategies to increase communities' access to cancer information, while helping the interns who are recruited from underrepresented communities gain admission to top graduate schools. Interns are taught basic health journalism skills that enable them to create immediate streams of cancer-related press releases for submission to community newspapers. Interns are charged with the social responsibility of continuing this dissemination process throughout their careers. Intermediate outcomes are measured as mediators of distal behavioral change goals.

Residential rurality and oral health disparities: influences of contextual and individual factors.

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Ahn, SangNam; Burdine, James N; Smith, Matthew Lee; Ory, Marcia G; Phillips, Charles D

2011-02-01

The purposes of the study were (a) to identify disparities between urban and rural adults in oral health and (b) to examine contextual (i.e., external environment and access to dental care) and individual (i.e., predisposing, enabling, and lifestyle behavioral) factors associated with oral health problems in a community population. Study data were derived from a two-stage, telephone-mailed survey conducted in 2006. The subjects were 2,591 adults aged 18 years and older. Cochran-Mantel-Haenszel statistics for categorical variables were applied to explore conditional independence between both health access and individual factors and oral health problems after controlling for the urban or rural residence. Logistic regression was used to investigate the simultaneous associations of contextual and individual factors in both rural and urban areas. Approximately one quarter (24.1%) of the study population reported oral health problems. Participants residing in rural areas reported more oral health disparities. Oral health problems were significantly associated with delaying dental care. These problems also were more common among those who were less educated, were African American, skipped breakfast every day, and currently smoked. The study findings suggest that oral health disparities persist for people in rural areas, and improving oral health status is strongly related to better access to oral health care and improved lifestyles in both rural and urban areas.

Health disparities and advertising content of women's magazines: a cross-sectional study

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Victorio Maria

2005-08-01

Full Text Available Abstract Background Disparities in health status among ethnic groups favor the Caucasian population in the United States on almost all major indicators. Disparities in exposure to health-related mass media messages may be among the environmental factors contributing to the racial and ethnic imbalance in health outcomes. This study evaluated whether variations exist in health-related advertisements and health promotion cues among lay magazines catering to Hispanic, African American and Caucasian women. Methods Relative and absolute assessments of all health-related advertising in 12 women's magazines over a three-month period were compared. The four highest circulating, general interest magazines oriented to Black women and to Hispanic women were compared to the four highest-circulating magazines aimed at a mainstream, predominantly White readership. Data were collected and analyzed in 2002 and 2003. Results Compared to readers of mainstream magazines, readers of African American and Hispanic magazines were exposed to proportionally fewer health-promoting advertisements and more health-diminishing advertisements. Photographs of African American role models were more often used to advertise products with negative health impact than positive health impact, while the reverse was true of Caucasian role models in the mainstream magazines. Conclusion To the extent that individual levels of health education and awareness can be influenced by advertising, variations in the quantity and content of health-related information among magazines read by different ethnic groups may contribute to racial disparities in health behaviors and health status.

Making sense of housing disparities research: a review of health and economic inequities.

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Narine, Lutchmie; Shobe, Marcia A

2014-01-01

Despite the recent recession and accompanying housing crisis, important gains have occurred in U.S. homeownership over the past several decades; however, wide inequalities among minority and immigrant populations remain. Understanding the role of several under-studied factors on housing outcomes, including health status and disability, and differences in financial capital, such as savings, investments, and other assets, remains a major policy initiative. Although past research has examined African American-White housing disparities, it is also important to explore disparities among Hispanics, Asians, and immigrants. This article reviews health and financial capital disparities in homeownership and home values between Whites and minority populations and offers suggestions for future policy research.

Child Health Disparities: What Can a Clinician Do?

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Cheng, Tina L.; Emmanuel, Mickey; Levy, Daniel J.; Jenkins, Renee R.

2015-01-01

Pediatric primary and specialty practice has changed with more to do, more regulation and more family needs. Similarly, the needs of patients have changed with more demographic diversity, family stress and continued health disparities by race, ethnicity and socioeconomic status. How can clinicians continue their dedicated service to children and ensure health equity in the face of these changes? This paper outlines specific, practical, actionable and evidence-based activities for clinicians t...

Funding a Health Disparities Research Agenda: The Case of Medicare Home Health Care

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Davitt, Joan K.

2014-01-01

Medicare home health care provides critical skilled nursing and therapy services to patients in their homes, generally after a period in an inpatient facility or nursing home. Disparities in access to, or outcomes of, home health care can result in patient deterioration and increased cost to the Medicare program if patient care needs intensify.…

Persisting problems related to race and ethnicity in public health and epidemiology research

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Jean-Claude Moubarac

2013-02-01

Full Text Available A recent and comprehensive review of the use of race and ethnicity in research that address health disparities in epidemiology and public health is provided. First it is described the theoretical basis upon which race and ethnicity differ drawing from previous work in anthropology, social science and public health. Second, it is presented a review of 280 articles published in high impacts factor journals in regards to public health and epidemiology from 2009-2011. An analytical grid enabled the examination of conceptual, theoretical and methodological questions related to the use of both concepts. The majority of articles reviewed were grounded in a theoretical framework and provided interpretations from various models. However, key problems identified include a a failure from researchers to differentiate between the concepts of race and ethnicity; b an inappropriate use of racial categories to ascribe ethnicity; c a lack of transparency in the methods used to assess both concepts; and d failure to address limits associated with the construction of racial or ethnic taxonomies and their use. In conclusion, future studies examining health disparities should clearly establish the distinction between race and ethnicity, develop theoretically driven research and address specific questions about the relationships between race, ethnicity and health. One argue that one way to think about ethnicity, race and health is to dichotomize research into two sets of questions about the relationship between human diversity and health.

Health and Health Care Disparities: The Effect of Social and Environmental Factors on Individual and Population Health

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Billy Thomas

2014-07-01

Full Text Available Recently the existence and prevalence of health and health care disparities has increased with accompanying research showing that minorities (African Americans, Hispanics/Latinos, Native Americans, and Pacific Islanders are disproportionately affected resulting in poorer health outcomes compared to non-minority populations (whites. This is due to multiple factors including and most importantly the social determinants of health which includes lower levels of education, overall lower socioeconomic status, inadequate and unsafe housing, and living in close proximity to environmental hazards; all contributing to poor health. Given the ever widening gap in health and health care disparities, the growing number of individuals living at or below the poverty level, the low number of college graduates and the growing shortage of health care professionals (especially minority the goals of this paper are to: (1 Define diversity and inclusion as interdependent entities. (2 Review the health care system as it relates to barriers/problems within the system resulting in the unequal distribution of quality health care. (3 Examine institutional and global benefits of increasing diversity in research. (4 Provide recommendations on institutional culture change and developing a diverse culturally competent healthcare workforce.

Disparities in Social Health by Sexual Orientation and the Etiologic Role of Self-Reported Discrimination.

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Doyle, David Matthew; Molix, Lisa

2016-08-01

Some past work indicates that sexual minorities may experience impairments in social health, or the perceived and actual availability and quality of one's social relationships, relative to heterosexuals; however, research has been limited in many ways. Furthermore, it is important to investigate etiological factors that may be associated with these disparities, such as self-reported discrimination. The current work tested whether sexual minority adults in the United States reported less positive social health (i.e., loneliness, friendship strain, familial strain, and social capital) relative to heterosexuals and whether self-reported discrimination accounted for these disparities. Participants for the current study (N = 579) were recruited via Amazon's Mechanical Turk, including 365 self-identified heterosexuals (105 women) and 214 sexual minorities (103 women). Consistent with hypotheses, sexual minorities reported impaired social health relative to heterosexuals, with divergent patterns emerging by sexual orientation subgroup (which were generally consistent across sexes). Additionally, self-reported discrimination accounted for disparities across three of four indicators of social health. These findings suggest that sexual minorities may face obstacles related to prejudice and discrimination that impair the functioning of their relationships and overall social health. Moreover, because social health is closely related to psychological and physical health, remediating disparities in social relationships may be necessary to address other health disparities based upon sexual orientation. Expanding upon these results, implications for efforts to build resilience among sexual minorities are discussed.

Nataniel, NAFTA, and Public Health at the U.S.-Mexico Border.

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Olson, Tom; Tapia, Sergio

2009-01-01

Advocating overall improvements in health for individuals and communities is a daunting but important task for nurses in particular, and for health care professionals in general. This is particularly true when focusing on the population along the 2,000-mile U.S.-Mexico border, a unique region in which distinct cultures, economies, and political systems meet. The purpose of this paper is to confront the assumption that trade and economic expansion automatically translate into improved public health, and to explore policy implications of the public health situation at the border. It uses a meta-narrative, an overarching story that draws on and illustrates collective stories from 300 participants in a study of mental health disparities, to argue for a more nuanced and complex understanding of health among the largely Hispanic population in this region.

The black cloud over the Sunshine State: health disparities in south Florida.

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Dyer, Janyce G

2003-01-01

Florida, the "Sunshine State", is paradise for international tourists and has been adopted as seasonal or permanent home by many wealthy individuals and celebrities. However, Florida is not paradise for the growing number of residents who suffer from poverty, health problems, and a lack of access to health care and social services. The purpose of this paper is to present data on health care problems and disparities throughout the state of Florida and in select south Florida counties. Flaskerud and Winslow (1998) have provided a framework which can be used to analyze disparities in resource availability, relative risk, and health status indicators and suggests areas in which nursing and other health professionals can ethically intervene through research, practice, and political action.

Disparities in HIV/AIDS, Viral Hepatitis, STDs, and TB

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... Search The CDC Health Disparities in HIV/AIDS, Viral Hepatitis, STDs, and TB Note: Javascript is disabled or ... Other Pacific Islanders MMWR Publications HIV and AIDS Viral Hepatitis STDs Tuberculosis Training and Networking Resources Call for ...

The influence of active coping and perceived stress on health disparities in a multi-ethnic low income sample

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Tomar Scott L

2008-01-01

Full Text Available Abstract Background Extensive research has shown that ethnic health disparities are prevalent and many psychological and social factors influence health disparities. Understanding what factors influence health disparities and how to eliminate health disparities has become a major research objective. The purpose of this study was to examine the impact of coping style, stress, socioeconomic status (SES, and discrimination on health disparities in a large urban multi-ethnic sample. Methods Data from 894 participants were collected via telephone interviews. Independent variables included: coping style, SES, sex, perceived stress, and perceived discrimination. Dependent variables included self-rated general and oral health status. Data analysis included multiple linear regression modeling. Results Coping style was related to oral health for Blacks (B = .23, p Conclusion Our results indicate that perceived stress is a critical component in understanding health outcomes for all ethnoracial groups. While SES related significantly to general health for Whites and Hispanics, this relationship was mediated by perceived stress. Active coping was associated only with oral health.

Understanding health-care access and utilization disparities among Latino children in the United States.

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Langellier, Brent A; Chen, Jie; Vargas-Bustamante, Arturo; Inkelas, Moira; Ortega, Alexander N

2016-06-01

It is important to understand the source of health-care disparities between Latinos and other children in the United States. We examine parent-reported health-care access and utilization among Latino, White, and Black children (≤17 years old) in the United States in the 2006-2011 National Health Interview Survey. Using Blinder-Oaxaca decomposition, we portion health-care disparities into two parts (1) those attributable to differences in the levels of sociodemographic characteristics (e.g., income) and (2) those attributable to differences in group-specific regression coefficients that measure the health-care 'return' Latino, White, and Black children receive on these characteristics. In the United States, Latino children are less likely than Whites to have a usual source of care, receive at least one preventive care visit, and visit a doctor, and are more likely to have delayed care. The return on sociodemographic characteristics explains 20-30% of the disparity between Latino and White children in the usual source of care, delayed care, and doctor visits and 40-50% of the disparity between Latinos and Blacks in emergency department use and preventive care. Much of the health-care disadvantage experienced by Latino children would persist if Latinos had the sociodemographic characteristics as Whites and Blacks. © The Author(s) 2014.

A Scoping Review of Health Disparities in Autism Spectrum Disorder

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Bishop-Fitzpatrick, Lauren; Kind, Amy J. H.

2017-01-01

Individuals with autism spectrum disorder (ASD) experience increased morbidity and decreased life expectancy compared to the general population, and these disparities are likely exacerbated for those individuals who are otherwise disadvantaged. We conducted a review to ascertain what is known about health and health system quality (e.g., high…

Growing partners: building a community-academic partnership to address health disparities in rural North Carolina.

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De Marco, Molly; Kearney, William; Smith, Tosha; Jones, Carson; Kearney-Powell, Arconstar; Ammerman, Alice

2014-01-01

Community-based participatory research (CBPR) holds tremendous promise for addressing public health disparities. As such, there is a need for academic institutions to build lasting partnerships with community organizations. Herein we have described the process of establishing a relationship between a research university and a Black church in rural North Carolina. We then discuss Harvest of Hope, the church-based pilot garden project that emerged from that partnership. The partnership began with a third-party effort to connect research universities with Black churches to address health disparities. Building this academic-community partnership included collaborating to determine research questions and programming priorities. Other aspects of the partnership included applying for funding together and building consensus on study budget and aims. The academic partners were responsible for administrative details and the community partners led programming and were largely responsible for participant recruitment. The community and academic partners collaborated to design and implement Harvest of Hope, a church-based pilot garden project involving 44 youth and adults. Community and academic partners shared responsibility for study design, recruitment, programming, and reporting of results. The successful operation of the Harvest of Hope project gave rise to a larger National Institutes of Health (NIH)-funded study, Faith, Farming and the Future (F3) involving 4 churches and 60 youth. Both projects were CBPR efforts to improve healthy food access and reducing chronic disease. This partnership continues to expand as we develop additional CBPR projects targeting physical activity, healthy eating, and environmental justice, among others. Benefits of the partnership include increased community ownership and cultural appropriateness of interventions. Challenges include managing expectations of diverse parties and adequate communication. Lessons learned and strategies for building

Religion and disparities: considering the influences of Islam on the health of American Muslims.

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Padela, Aasim I; Curlin, Farr A

2013-12-01

Both theory and data suggest that religions shape the way individuals interpret and seek help for their illnesses. Yet, health disparities research has rarely examined the influence of a shared religion on the health of individuals from distinct minority communities. In this paper, we focus on Islam and American Muslims to outline the ways in which a shared religion may impact the health of a racially, ethnically, and socioeconomically diverse minority community. We use Kleinman's "cultural construction of clinical reality" as a theoretical framework to interpret the extant literature on American Muslim health. We then propose a research agenda that would extend current disparities research to include measures of religiosity, particularly among populations that share a minority religious affiliation. The research we propose would provide a fuller understanding of the relationships between religion and health among Muslim Americans and other minority communities and would thereby undergird efforts to reduce unwarranted health disparities.

Disparities in health, poverty, incarceration, and social justice among racial groups in the United States: a critical review of evidence of close links with neoliberalism.

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Nkansah-Amankra, Stephen; Agbanu, Samuel Kwami; Miller, Reuben Jonathan

2013-01-01

Problems of poverty, poor health, and incarceration are unevenly distributed among racial and ethnic minorities in the United States. We argue that this is due, in part, to the ascendance of United States-style neoliberalism, a prevailing political and economic doctrine that shapes social policy, including public health and anti-poverty intervention strategies. Public health research most often associates inequalities in health outcomes, poverty, and incarceration with individual and cultural risk factors. Contextual links to structural inequality and the neoliberal doctrine animating state-sanctioned interventions are given less attention. The interrelationships among these are not clear in the extant literature. Less is known about public health and incarceration. Thus, the authors describe the linkages between neoliberalism, public health, and criminal justice outcomes. We suggest that neoliberalism exacerbates racial disparities in health, poverty, and incarceration in the United States. We conclude by calling for a new direction in public health research that advances a pro-poor public health agenda to improve the general well-being of disadvantaged groups.

Comprehensive effective and efficient global public health surveillance

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McNabb Scott JN

2010-12-01

Full Text Available Abstract At a crossroads, global public health surveillance exists in a fragmented state. Slow to detect, register, confirm, and analyze cases of public health significance, provide feedback, and communicate timely and useful information to stakeholders, global surveillance is neither maximally effective nor optimally efficient. Stakeholders lack a globa surveillance consensus policy and strategy; officials face inadequate training and scarce resources. Three movements now set the stage for transformation of surveillance: 1 adoption by Member States of the World Health Organization (WHO of the revised International Health Regulations (IHR[2005]; 2 maturation of information sciences and the penetration of information technologies to distal parts of the globe; and 3 consensus that the security and public health communities have overlapping interests and a mutual benefit in supporting public health functions. For these to enhance surveillance competencies, eight prerequisites should be in place: politics, policies, priorities, perspectives, procedures, practices, preparation, and payers. To achieve comprehensive, global surveillance, disparities in technical, logistic, governance, and financial capacities must be addressed. Challenges to closing these gaps include the lack of trust and transparency; perceived benefit at various levels; global governance to address data power and control; and specified financial support from globa partners. We propose an end-state perspective for comprehensive, effective and efficient global, multiple-hazard public health surveillance and describe a way forward to achieve it. This end-state is universal, global access to interoperable public health information when it’s needed, where it’s needed. This vision mitigates the tension between two fundamental human rights: first, the right to privacy, confidentiality, and security of personal health information combined with the right of sovereign, national entities

Comprehensive effective and efficient global public health surveillance.

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McNabb, Scott J N

2010-12-03

At a crossroads, global public health surveillance exists in a fragmented state. Slow to detect, register, confirm, and analyze cases of public health significance, provide feedback, and communicate timely and useful information to stakeholders, global surveillance is neither maximally effective nor optimally efficient. Stakeholders lack a globa surveillance consensus policy and strategy; officials face inadequate training and scarce resources.Three movements now set the stage for transformation of surveillance: 1) adoption by Member States of the World Health Organization (WHO) of the revised International Health Regulations (IHR[2005]); 2) maturation of information sciences and the penetration of information technologies to distal parts of the globe; and 3) consensus that the security and public health communities have overlapping interests and a mutual benefit in supporting public health functions. For these to enhance surveillance competencies, eight prerequisites should be in place: politics, policies, priorities, perspectives, procedures, practices, preparation, and payers.To achieve comprehensive, global surveillance, disparities in technical, logistic, governance, and financial capacities must be addressed. Challenges to closing these gaps include the lack of trust and transparency; perceived benefit at various levels; global governance to address data power and control; and specified financial support from globa partners.We propose an end-state perspective for comprehensive, effective and efficient global, multiple-hazard public health surveillance and describe a way forward to achieve it. This end-state is universal, global access to interoperable public health information when it's needed, where it's needed. This vision mitigates the tension between two fundamental human rights: first, the right to privacy, confidentiality, and security of personal health information combined with the right of sovereign, national entities to the ownership and stewardship

Disparities in Diabetes Care Quality by English Language Preference in Community Health Centers.

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Leung, Lucinda B; Vargas-Bustamante, Arturo; Martinez, Ana E; Chen, Xiao; Rodriguez, Hector P

2018-02-01

To conduct a parallel analysis of disparities in diabetes care quality among Latino and Asian community health center (CHC) patients by English language preference. Clinical outcomes (2011) and patient survey data (2012) for Type 2 diabetes adults from 14 CHCs (n = 1,053). We estimated separate regression models for Latino and Asian patients by English language preference for Clinician & Group-Consumer Assessment of Healthcare Providers and System, Patient Assessment of Chronic Illness Care, hemoglobin A1c, and self-reported hypoglycemic events. We used the Blinder-Oaxaca decomposition method to parse out observed and unobserved differences in outcomes between English versus non-English language groups. After adjusting for socioeconomic and health characteristics, disparities in patient experiences by English language preference were found only among Asian patients. Unobserved factors largely accounted for linguistic disparities for most patient experience measures. There were no significant differences in glycemic control by language for either Latino or Asian patients. Given the importance of patient retention in CHCs, our findings indicate opportunities to improve CHC patients' experiences of care and to reduce disparities in patient experience by English preference for Asian diabetes patients. © Health Research and Educational Trust.

77 FR 66623 - National Institute on Minority Health and Health Disparities; Notice of Closed Meeting

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2012-11-06

... and Health Disparities Special Emphasis Panel; NIMHD Community-Based Participatory Research (CBPR... Marriott Suites, 6711 Democracy Boulevard, Bethesda, MD 20817. Contact Person: Robert Nettey, M.D., Chief... of Health, 6707 Democracy Blvd., Suite 800, Bethesda, MD 20892, (301) 496-3996, [email protected

Effects of Geography on Mental Health Disparities on Sexual Minorities in New York City.

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Felson, Jacob; Adamczyk, Amy

2018-05-01

Gay and lesbian individuals have higher rates of psychological distress than do heterosexual individuals. The minority stress hypothesis attributes this disparity to adversity-related stress experienced by sexual minorities. In support of this idea, research in the U.S. has generally found that mental health disparities between sexual minorities and others are narrower in places where tolerance is relatively high. However, few studies have examined disparities between sexual minorities and others in neighborhoods where sexual minorities are most highly concentrated. Likewise, little research attention has been given to disparities for people who move to more tolerant places from less tolerant states and countries. Using data from the New York City Community Health Survey, we found some evidence that disparities between sexual minorities and others were lower in areas with higher concentrations of sexual minorities. However, disparities did not vary by the tolerance level of the state of birth among those born in the U.S. and were actually lower among those born in the least tolerant nations. These results complicate the idea that there is a dose-response relationship between tolerance and psychological distress among sexual minorities.

Editorial: 2nd Special Issue on behavior change, health, and health disparities.

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Higgins, Stephen T

2015-11-01

This Special Issue of Preventive Medicine (PM) is the 2nd that we have organized on behavior change, health, and health disparities. This is a topic of fundamental importance to improving population health in the U.S. and other industrialized countries that are trying to more effectively manage chronic health conditions. There is broad scientific consensus that personal behavior patterns such as cigarette smoking, other substance abuse, and physical inactivity/obesity are among the most important modifiable causes of chronic disease and its adverse impacts on population health. As such behavior change needs to be a key component of improving population health. There is also broad agreement that while these problems extend across socioeconomic strata, they are overrepresented among more economically disadvantaged populations and contribute directly to the growing problem of health disparities. Hence, behavior change represents an essential step in curtailing that unsettling problem as well. In this 2nd Special Issue, we devote considerable space to the current U.S. prescription opioid addiction epidemic, a crisis that was not addressed in the prior Special Issue. We also continue to devote attention to the two largest contributors to preventable disease and premature death, cigarette smoking and physical inactivity/obesity as well as risks of co-occurrence of these unhealthy behavior patterns. Across each of these topics we included contributions from highly accomplished policy makers and scientists to acquaint readers with recent accomplishments as well as remaining knowledge gaps and challenges to effectively managing these important chronic health problems. Copyright © 2015 Elsevier Inc. All rights reserved.

Health disparities from economic burden of diabetes in middle-income countries: evidence from México.

Directory of Open Access Journals (Sweden)

Armando Arredondo

Full Text Available The rapid growth of diabetes in middle-income countries is generating disparities in global health. In this context we conducted a study to quantify the health disparities from the economic burden of diabetes in México. Evaluative research based on a longitudinal design, using cost methodology by instrumentation. For the estimation of epidemiological changes during the 2010-2012 period, several probabilistic models were developed using the Box-Jenkins technique. The financial requirements were obtained from expected case management costs by disease and the application of an econometric adjustment factor to control the effects of inflation. Comparing the economic impact in 2010 versus 2012 (p<0.05, there was a 33% increase in financial requirements. The total amount for diabetes in 2011 (US dollars was $7.7 billion. It includes $3.4 billion in direct costs and $4.3 in indirect costs. The total direct costs were $.4 billion to the Ministry of Health (SSA, serving the uninsured population; $1.2 to the institutions serving the insured population (Mexican Institute for Social Security-IMSS-, and Institute for Social Security and Services for State Workers-ISSSTE-; $1.8 to users; and $.1 to Private Health Insurance (PHI. If the risk factors and the different health care models remain as they currently are in the analyzed institutions, health disparities in terms of financial implications will have the greatest impact on users' pockets. In middle-income countries, health disparities generated by the economic burden of diabetes is one of the main reasons for catastrophic health expenditure. Health disparities generated by the economic burden of diabetes suggests the need to design and review the current organization of health systems and the relevance of moving from biomedical models and curative health care to preventive and socio-medical models to meet expected challenges from diseases like diabetes in middle-income countries.

Socioeconomic and racial/ethnic oral health disparities among US older adults: oral health quality of life and dentition.

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Huang, Deborah L; Park, Mijung

2015-01-01

This study aims to examine if older adults living in poverty and from minority racial/ethnic groups experienced disproportionately high rates of poor oral health outcomes measured by oral health quality of life (OHQOL) and number of permanent teeth. Cross-sectional analysis of 2,745 community-dwelling adults aged ≥65 years from the National Health and Nutrition Examination Survey (NHANES) 2005-2008. Oral health outcomes were assessed by questionnaire using the NHANES-Oral Health Impact Profile for OHQOL and standardized examination for dentition. Logistic and linear regression analyses were used to determine the association between oral health outcomes and predictors of interest. All analyses were weighted to account for complex survey sampling methods. Both poverty and minority race/ethnicity were significantly associated with poor oral health outcomes in OHQOL and number of permanent teeth. Distribution of scores for each OHQOL domain varied by minority racial/ethnic group. Oral health disparities persist in older adults living in poverty and among those from minority racial/ethnic groups. The racial/ethnic variation in OHQOL domains should be further examined to develop interventions to improve the oral health of these groups. © 2014 American Association of Public Health Dentistry.

Mapping Medicare Disparities Tool

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U.S. Department of Health & Human Services — The CMS Office of Minority Health has designed an interactive map, the Mapping Medicare Disparities Tool, to identify areas of disparities between subgroups of...

A Synergistic Approach to Human Rights and Public Health Ethics: Effective or a Source of Conflict?

Directory of Open Access Journals (Sweden)

Steinmetz-Wood, Madeleine

2014-12-01

Full Text Available Concerns over the growing disparities in health and wealth between members of society incited Stephanie Nixon and Lisa Forman, in their 2008 article Exploring synergies between human rights and public health ethics: A whole greater than the sum of its parts, to propose that the principles of human rights and public health ethics should be used in combination to develop norms for health action. This commentary reflects on the benefits as well as the difficulties that could arise from taking such an approach.

Disparities in health insurance among children with same-sex parents.

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Gonzales, Gilbert; Blewett, Lynn A

2013-10-01

The objectives of this study were to examine disparities in health insurance coverage for children with same-sex parents and to investigate how statewide policies such as same-sex marriage and second-parent adoptions affect children's private insurance coverage. We used data from the 2008-2010 American Community Survey to identify children (aged 0-17 years) with same-sex parents (n = 5081), married opposite-sex parents (n = 1369789), and unmarried opposite-sex parents (n = 101678). We conducted multinomial logistic regression models to estimate the relationship between family type and type of health insurance coverage for all children and then stratified by each child's state policy environment. Although 77.5% of children with married opposite-sex parents had private health insurance, only 63.3% of children with dual fathers and 67.5% with dual mothers were covered by private health plans. Children with same-sex parents had fewer odds of private insurance after controlling for demographic characteristics but not to the extent of children with unmarried opposite-sex parents. Differences in private insurance diminished for children with dual mothers after stratifying children in states with legal same-sex marriage or civil unions. Living in a state that allowed second-parent adoptions also predicted narrower disparities in private insurance coverage for children with dual fathers or dual mothers. Disparities in private health insurance for children with same-sex parents diminish when they live in states that secure their legal relationship to both parents. This study provides supporting evidence in favor of recent policy statements by the American Academy of Pediatricians endorsing same-sex marriage and second-parent adoptions.

Does place explain racial health disparities? Quantifying the contribution of residential context to the Black/white health gap in the United States.

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Do, D Phuong; Finch, Brian Karl; Basurto-Davila, Ricardo; Bird, Chloe; Escarce, Jose; Lurie, Nicole

2008-10-01

The persistence of the black health disadvantage has been a puzzling component of health in the United States in spite of general declines in rates of morbidity and mortality over the past century. Studies that have focused on well-established individual-level determinants of health such as socio-economic status and health behaviors have been unable to fully explain these disparities. Recent research has begun to focus on other factors such as racism, discrimination, and segregation. Variation in neighborhood context-socio-demographic composition, social aspects, and built environment-has been postulated as an additional explanation for racial disparities, but few attempts have been made to quantify its overall contribution to the black/white health gap. This analysis is an attempt to generate an estimate of place effects on explaining health disparities by utilizing data from the U.S. National Health Interview Survey (NHIS) (1989-1994), combined with a methodology for identifying residents of the same blocks both within and across NHIS survey cross-sections. Our results indicate that controlling for a single point-in-time measure of residential context results in a roughly 15-76% reduction of the black/white disparities in self-rated health that were previously unaccounted for by individual-level controls. The contribution of residential context toward explaining the black/white self-rated health gap varies by both age and gender such that contextual explanations of disparities decline with age and appear to be smaller among females.

Tracking Biocultural Pathways to Health Disparities: The Value of Biomarkers

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Worthman, Carol M.; Costello, E. Jane

2009-01-01

Background Cultural factors and biomarkers are emerging emphases in social epidemiology that readily ally with human biology and anthropology. Persistent health challenges and disparities have established biocultural roots, and environment plays an integral role in physical development and function that form the bases of population health. Biomarkers have proven to be valuable tools for investigating biocultural bases of health disparities. Aims We apply recent insights from biology to consider how culture gets under the skin and evaluate the construct of embodiment. We analyze contrasting biomarker models and applications, and propose an integrated model for biomarkers. Three examples from the Great Smoky Mountains Study (GSMS) illustrate these points. Subjects and methods The longitudinal developmental epidemiological GSMS comprises a population-based sample of 1420 children with repeated measures including mental and physical health, life events, household conditions, and biomarkers for pubertal development and allostatic load. Results Analyses using biomarkers resolved competing explanations for links between puberty and depression, identified gender differences in stress at puberty, and revealed interactive effects of birthweight and postnatal adversity on risk for depression at puberty in girls. Conclusion An integrated biomarker model can both enrich epidemiology and illuminate biocultural pathways in population health. PMID:19381986

Shedding Light on the Mechanisms Underlying Health Disparities Through Community Participatory Methods: The Stress Pathway

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Schetter, Christine Dunkel; Schafer, Peter; Lanzi, Robin Gaines; Clark-Kauffman, Elizabeth; Raju, Tonse N. K.; Hillemeier, Marianne M.

2015-01-01

Health disparities are large and persistent gaps in the rates of disease and death between racial/ethnic and socioeconomic status subgroups in the population. Stress is a major pathway hypothesized to explain such disparities. The Eunice Kennedy Shriver National Institute of Child Health and Human Development formed a community/research collaborative—the Community Child Health Network—to investigate disparities in maternal and child health in five high-risk communities. Using community participation methods, we enrolled a large cohort of African American/Black, Latino/Hispanic, and non-Hispanic/White mothers and fathers of newborns at the time of birth and followed them over 2 years. A majority had household incomes near or below the federal poverty level. Home interviews yielded detailed information regarding multiple types of stress such as major life events and many forms of chronic stress including racism. Several forms of stress varied markedly by racial/ethnic group and income, with decreasing stress as income increased among Caucasians but not among African Americans; other forms of stress varied by race/ethnicity or poverty alone. We conclude that greater sophistication in studying the many forms of stress and community partnership is necessary to uncover the mechanisms underlying health disparities in poor and ethnic-minority families and to implement community health interventions. PMID:26173227

Health Benefits Mandates and Their Potential Impacts on Racial/Ethnic Group Disparities in Insurance Markets.

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Charles, Shana Alex; Ponce, Ninez; Ritley, Dominique; Guendelman, Sylvia; Kempster, Jennifer; Lewis, John; Melnikow, Joy

2017-08-01

Addressing racial/ethnic group disparities in health insurance benefits through legislative mandates requires attention to the different proportions of racial/ethnic groups among insurance markets. This necessary baseline data, however, has proven difficult to measure. We applied racial/ethnic data from the 2009 California Health Interview Survey to the 2012 California Health Benefits Review Program Cost and Coverage Model to determine the racial/ethnic composition of ten health insurance market segments. We found disproportional representation of racial/ethnic groups by segment, thus affecting the health insurance impacts of benefit mandates. California's Medicaid program is disproportionately Latino (60 % in Medi-Cal, compared to 39 % for the entire population), and the individual insurance market is disproportionately non-Latino white. Gender differences also exist. Mandates could unintentionally increase insurance coverage racial/ethnic disparities. Policymakers should consider the distribution of existing racial/ethnic disparities as criteria for legislative action on benefit mandates across health insurance markets.

A roadmap and best practices for organizations to reduce racial and ethnic disparities in health care.

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Chin, Marshall H; Clarke, Amanda R; Nocon, Robert S; Casey, Alicia A; Goddu, Anna P; Keesecker, Nicole M; Cook, Scott C

2012-08-01

Over the past decade, researchers have shifted their focus from documenting health care disparities to identifying solutions to close the gap in care. Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation, is charged with identifying promising interventions to reduce disparities. Based on our work conducting systematic reviews of the literature, evaluating promising practices, and providing technical assistance to health care organizations, we present a roadmap for reducing racial and ethnic disparities in care. The roadmap outlines a dynamic process in which individual interventions are just one part. It highlights that organizations and providers need to take responsibility for reducing disparities, establish a general infrastructure and culture to improve quality, and integrate targeted disparities interventions into quality improvement efforts. Additionally, we summarize the major lessons learned through the Finding Answers program. We share best practices for implementing disparities interventions and synthesize cross-cutting themes from 12 systematic reviews of the literature. Our research shows that promising interventions frequently are culturally tailored to meet patients' needs, employ multidisciplinary teams of care providers, and target multiple leverage points along a patient's pathway of care. Health education that uses interactive techniques to deliver skills training appears to be more effective than traditional didactic approaches. Furthermore, patient navigation and engaging family and community members in the health care process may improve outcomes for minority patients. We anticipate that the roadmap and best practices will be useful for organizations, policymakers, and researchers striving to provide high-quality equitable care.

A simulation model approach to analysis of the business case for eliminating health care disparities

Directory of Open Access Journals (Sweden)

Tunceli Kaan

2011-03-01

Full Text Available Abstract Background Purchasers can play an important role in eliminating racial and ethnic disparities in health care. A need exists to develop a compelling "business case" from the employer perspective to put, and keep, the issue of racial/ethnic disparities in health care on the quality improvement agenda for health plans and providers. Methods To illustrate a method for calculating an employer business case for disparity reduction and to compare the business case in two clinical areas, we conducted analyses of the direct (medical care costs paid by employers and indirect (absenteeism, productivity effects of eliminating known racial/ethnic disparities in mammography screening and appropriate medication use for patients with asthma. We used Markov simulation models to estimate the consequences, for defined populations of African-American employees or health plan members, of a 10% increase in HEDIS mammography rates or a 10% increase in appropriate medication use among either adults or children/adolescents with asthma. Results The savings per employed African-American woman aged 50-65 associated with a 10% increase in HEDIS mammography rate, from direct medical expenses and indirect costs (absenteeism, productivity combined, was $50. The findings for asthma were more favorable from an employer point of view at approximately $1,660 per person if raising medication adherence rates in African-American employees or dependents by 10%. Conclusions For the employer business case, both clinical scenarios modeled showed positive results. There is a greater potential financial gain related to eliminating a disparity in asthma medications than there is for eliminating a disparity in mammography rates.

A simulation model approach to analysis of the business case for eliminating health care disparities.

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Nerenz, David R; Liu, Yung-wen; Williams, Keoki L; Tunceli, Kaan; Zeng, Huiwen

2011-03-19

Purchasers can play an important role in eliminating racial and ethnic disparities in health care. A need exists to develop a compelling "business case" from the employer perspective to put, and keep, the issue of racial/ethnic disparities in health care on the quality improvement agenda for health plans and providers. To illustrate a method for calculating an employer business case for disparity reduction and to compare the business case in two clinical areas, we conducted analyses of the direct (medical care costs paid by employers) and indirect (absenteeism, productivity) effects of eliminating known racial/ethnic disparities in mammography screening and appropriate medication use for patients with asthma. We used Markov simulation models to estimate the consequences, for defined populations of African-American employees or health plan members, of a 10% increase in HEDIS mammography rates or a 10% increase in appropriate medication use among either adults or children/adolescents with asthma. The savings per employed African-American woman aged 50-65 associated with a 10% increase in HEDIS mammography rate, from direct medical expenses and indirect costs (absenteeism, productivity) combined, was $50. The findings for asthma were more favorable from an employer point of view at approximately $1,660 per person if raising medication adherence rates in African-American employees or dependents by 10%. For the employer business case, both clinical scenarios modeled showed positive results. There is a greater potential financial gain related to eliminating a disparity in asthma medications than there is for eliminating a disparity in mammography rates. © 2011 Nerenz et al; licensee BioMed Central Ltd.

Integrating Multiple Social Statuses in Health Disparities Research: The Case of Lung Cancer

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Williams, David R; Kontos, Emily Z; Viswanath, K; Haas, Jennifer S; Lathan, Christopher S; MacConaill, Laura E; Chen, Jarvis; Ayanian, John Z

2012-01-01

Objective To illustrate the complex patterns that emerge when race/ethnicity, socioeconomic status (SES), and gender are considered simultaneously in health care disparities research and to outline the needed research to understand them by using disparities in lung cancer risks, treatment, and outcomes as an example. Principal Findings SES, gender, and race/ethnicity are social categories that are robust predictors of variations in health and health services utilization. These are usually considered separately, but intersectionality theory indicates that the impact of each depends on the others. Each reflects historically and culturally contingent variations in social, economic, and political status. Distinct patterns of risk and resilience emerge at the intersections of multiple social categories and shape the experience of health, health care access, utilization, quality, and outcomes where these categories intersect. Intersectional approaches call for greater attention to understand social processes at multiple levels of society and require the collection of relevant data and utilization of appropriate analytic approaches to understand how multiple risk factors and resources combine to affect the distribution of disease and its management. Conclusions Understanding how race/ethnicity, gender, and SES are interactive, interdependent, and social identities can provide new knowledge to enhance our efforts to effectively address health disparities. PMID:22568674

Increased Mental Health Treatment Financing, Community-Based Organization's Treatment Programs, and Latino-White Children's Financing Disparities.

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Snowden, Lonnie R; Wallace, Neal; Cordell, Kate; Graaf, Genevieve

2017-09-01

Latino child populations are large and growing, and they present considerable unmet need for mental health treatment. Poverty, lack of health insurance, limited English proficiency, stigma, undocumented status, and inhospitable programming are among many factors that contribute to Latino-White mental health treatment disparities. Lower treatment expenditures serve as an important marker of Latino children's low rates of mental health treatment and limited participation once enrolled in services. We investigated whether total Latino-White expenditure disparities declined when autonomous, county-level mental health plans receive funds free of customary cost-sharing charges, especially when they capitalized on cultural and language-sensitive mental health treatment programs as vehicles to receive and spend treatment funds. Using Whites as benchmark, we considered expenditure pattern disparities favoring Whites over Latinos and, in a smaller number of counties, Latinos over Whites. Using segmented regression for interrupted time series on county level treatment systems observed over 64 quarters, we analyzed Medi-Cal paid claims for per-user total expenditures for mental health services delivered to children and youth (under 18 years of age) during a study period covering July 1, 1991 through June 30, 2007. Settlement-mandated Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. Terms were introduced to assess immediate and long term inequality reduction as well as the role of culture and language-sensitive community-based programs. Settlement-mandated increased EPSDT treatment funding was associated with more spending on Whites relative to Latinos unless plans arranged for cultural and language-sensitive mental health treatment programs. However, having programs served more to prevent expenditure disparities from growing than to reduce disparities. EPSDT expanded funding increased proportional

'Where is the public health sector?' Public and private sector healthcare provision in Madhya Pradesh, India.

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De Costa, Ayesha; Diwan, Vinod

2007-12-01

This paper aims to empirically demonstrate the size and composition of the private health care sector in one of India's largest provinces, Madhya Pradesh. It is based on a field survey of all health care providers in Madhya Pradesh (60.4 million in 52,117 villages and 394 towns). Seventy-five percent of the population is rural and 37% live below poverty line. This survey was done as part of the development of a health management information system. The distribution of health care providers in the province with regard to sector of work (public/private), rural-urban location, qualification, commercial orientation and institutional set-up are described. Of the 24,807 qualified doctors mapped in the survey, 18,757 (75.6%) work in the private sector. Fifteen thousand one hundred forty-two (80%) of these private physicians work in urban areas. The 72.1% (67793) of all qualified paramedical staff work in the private sector, mostly in rural areas. The paper empirically demonstrates the dominant heterogeneous private health sector and the overall the disparity in healthcare provision in rural and urban areas. It argues for a new role for the public health sector, one of constructive oversight over the entire health sector (public and private) balanced with direct provision of services where necessary. It emphasizes the need to build strong public private partnerships to ensure equitable access to healthcare for all.

Implicit bias and its relation to health disparities: a teaching program and survey of medical students.

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Gonzalez, Cristina M; Kim, Mimi Y; Marantz, Paul R

2014-01-01

The varying treatment of different patients by the same physician are referred to as within provider disparities. These differences can contribute to health disparities and are thought to be the result of implicit bias due to unintentional, unconscious assumptions. The purpose is to describe an educational intervention addressing both health disparities and physician implicit bias and the results of a subsequent survey exploring medical students' attitudes and beliefs toward subconscious bias and health disparities. A single session within a larger required course was devoted to health disparities and the physician's potential to contribute to health disparities through implicit bias. Following the session the students were anonymously surveyed on their Implicit Association Test (IAT) results, their attitudes and experiences regarding the fairness of the health care system, and the potential impact of their own implicit bias. The students were categorized based on whether they disagreed ("deniers") or agreed ("accepters") with the statement "Unconscious bias might affect some of my clinical decisions or behaviors." Data analysis focused specifically on factors associated with this perspective. The survey response rate was at least 69%. Of the responders, 22% were "deniers" and 77% were "accepters." Demographics between the two groups were not significantly different. Deniers were significantly more likely than accepters to report IAT results with implicit preferences toward self, to believe the IAT is invalid, and to believe that doctors and the health system provide equal care to all and were less likely to report having directly observed inequitable care. The recognition of bias cannot be taught in a single session. Our experience supports the value of teaching medical students to recognize their own implicit biases and develop skills to overcome them in each patient encounter, and in making this instruction part of the compulsory, longitudinal undergraduate

Increasing educational disparities in premature adult mortality, Wisconsin, 1990-2000.

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Reither, Eric N; Peppard, Paul E; Remington, Patrick L; Kindig, David A

2006-10-01

Public health agencies have identified the elimination of health disparities as a major policy objective. The primary objective of this study is to assess changes in the association between education and premature adult mortality in Wisconsin, 1990-2000. Wisconsin death records (numerators) and US Census data (denominators) were compiled to estimate mortality rates among adults (25-64 years) in 1990 and 2000. Information on the educational status, sex, racial identification, and age of subjects was gathered from these sources. The effect of education on mortality rate ratios in 1990 and 2000 was assessed while adjusting for age, sex, and racial identification. Education exhibited a graded effect on mortality rates, which declined most among college graduates from 1990 to 2000. The relative rate of mortality among persons with less than a high school education compared to persons with a college degree increased from 2.4 to 3.1 from 1990-2000-an increase of 29%. Mortality disparities also increased, although to a lesser extent, among other educational groups. Despite renewed calls for the elimination of health disparities, evidence suggests that educational disparities in mortality increased from 1990 to 2000.

What Makes African American Health Disparities Newsworthy? An Experiment among Journalists about Story Framing

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Hinnant, Amanda; Oh, Hyun Jee; Caburnay, Charlene A.; Kreuter, Matthew W.

2011-01-01

News stories reporting race-specific health information commonly emphasize disparities between racial groups. But recent research suggests this focus on disparities has unintended effects on African American audiences, generating negative emotions and less interest in preventive behaviors (Nicholson RA, Kreuter MW, Lapka C "et al." Unintended…

Cancer Disparities - Cancer Currents Blog

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Blog posts on cancer health disparities research—including factors that influence disparities, disparities-related research efforts, and diversity in the cancer research workforce—from NCI Cancer Currents.

Integrating Interprofessional Education and Cultural Competency Training to Address Health Disparities.

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McElfish, Pearl Anna; Moore, Ramey; Buron, Bill; Hudson, Jonell; Long, Christopher R; Purvis, Rachel S; Schulz, Thomas K; Rowland, Brett; Warmack, T Scott

2018-01-01

Many U.S. medical schools have accreditation requirements for interprofessional education and training in cultural competency, yet few programs have developed programs to meet both of these requirements simultaneously. Furthermore, most training programs to address these requirements are broad in nature and do not focus on addressing health disparities. The lack of integration may reduce the students' ability to apply the knowledge learned. Innovative programs that combine these two learning objectives and focus on disenfranchised communities are needed to train the next generation of health professionals. A unique interprofessional education program was developed at the University of Arkansas for Medical Sciences Northwest. The program includes experiential learning, cultural exposure, and competence-building activities for interprofessional teams of medicine, nursing, and pharmacy students. The activities include (a) educational seminars, (b) clinical experiential learning in a student-led clinic, and (c) community-based service-learning through health assessments and survey research events. The program focuses on interprofessional collaboration to address the health disparities experienced by the Marshallese community in northwest Arkansas. The Marshallese are Pacific Islanders who suffer from significant health disparities related to chronic and infectious diseases. Comparison tests revealed statistically significant changes in participants' retrospectively reported pre/posttest scores for Subscales 1 and 2 of the Readiness for Interpersonal Learning Scale and for the Caffrey Cultural Competence in Healthcare Scale. However, no significant change was found for Subscale 3 of the Readiness for Interpersonal Learning Scale. Qualitative findings demonstrated a change in students' knowledge, attitudes, and behavior toward working with other professions and the underserved population. The program had to be flexible enough to meet the educational requirements and

Trends in Longevity in the Americas: Disparities in Life Expectancy in Women and Men, 1965-2010.

Directory of Open Access Journals (Sweden)

Ian R Hambleton

Full Text Available We describe trends in life expectancy at birth (LE and between-country LE disparities since 1965, in Latin America and the Caribbean.LE trends since 1965 are described for three geographical sub-regions: the Caribbean, Central America, and South America. LE disparities are explored using a suite of absolute and relative disparity metrics, with measurement consensus providing confidence to observed differences. LE has increased throughout Latin America and the Caribbean. Compared to the Caribbean, LE has increased by an additional 6.6 years in Central America and 4.1 years in South America. Since 1965, average reductions in between-country LE disparities were 14% (absolute disparity and 23% (relative disparity in the Caribbean, 55% and 51% in Central America, 55% and 52% in South America.LE in Latin America and the Caribbean is exceeding 'minimum standard' international targets, and is improving relative to the world region with the highest human longevity. The Caribbean, which had the highest LE and the lowest between-country LE disparities in Latin America and the Caribbean in 1965-70, had the lowest LE and the highest LE disparities by 2005-10. Caribbean Governments have championed a collaborative solution to the growing burden of non-communicable disease, with 15 territories signing on to the Declaration of Port of Spain, signalling regional commitment to a coordinated public-health response. The persistent LE inequity between Caribbean countries suggests that public health interventions should be tailored to individual countries to be most effective. Between- and within-country disparity monitoring for a range of health metrics should be a priority, first to guide country-level policy initiatives, then to contribute to the assessment of policy success.

Social Determinants of Racial/Ethnic Health Disparities in Children and Adolescents

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Price, James H.; McKinney, Molly A.; Braun, Robert E.

2011-01-01

Too many racial/ethnic minorities do not reach their full potential for a healthy and rewarding life. This paper addresses the social determinants that impact, either directly or indirectly, child and adolescent health disparities. Understanding the role social determinants play in the life course of health status can help guide educational…

Are socioeconomic disparities in health behavior mediated by differential media use? Test of the communication inequality theory.

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Ishikawa, Yoshiki; Kondo, Naoki; Kawachi, Ichiro; Viswanath, Kasisomayajula

2016-11-01

Communication inequality has been offered as one potential mechanism through which social determinants influence multiple health behaviors. The purpose of this study was to examine the underlying mechanisms between communication inequality and health behaviors. Data from a nationally representative cross-sectional survey of 18,426 people aged 18 years and above in the United States were used for secondary analysis. Measures included socio-demographic characteristics, social participation (structural social capital), health media use (TV, print, and the Internet), and five health behaviors (physical activity, cigarette smoking, alcohol use, and intake of fruit and vegetable). Path analysis was performed to examine the linkages between social determinants, health media use, social participation, and social gradients in health behaviors. Path analysis revealed that socioeconomic gradients in health behaviors is mediated by: 1) inequalities in health media use; 2) disparities in social participation, which leads to differential media use; and 3) disparities in social participation that are not mediated by media use. Consistent with the theory of communication inequality, socioeconomic disparities in media use partially mediate disparities in multiple health behaviors. To address health inequalities, it is important to utilize health media to target populations with low socioeconomic statuses. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Disparities in health-related Internet use among African American men, 2010.

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Mitchell, Jamie A; Thompson, Hayley S; Watkins, Daphne C; Shires, Deirdre; Modlin, Charles S

2014-03-20

Given the benefits of health-related Internet use, we examined whether sociodemographic, medical, and access-related factors predicted this outcome among African American men, a population burdened with health disparities. African American men (n = 329) completed an anonymous survey at a community health fair in 2010; logistic regression was used to identify predictors. Only education (having attended some college or more) predicted health-related Internet use (P Internet use.

Shedding Light on the Mechanisms Underlying Health Disparities Through Community Participatory Methods: The Stress Pathway.

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Dunkel Schetter, Christine; Schafer, Peter; Lanzi, Robin Gaines; Clark-Kauffman, Elizabeth; Raju, Tonse N K; Hillemeier, Marianne M

2013-11-01

Health disparities are large and persistent gaps in the rates of disease and death between racial/ethnic and socioeconomic status subgroups in the population. Stress is a major pathway hypothesized to explain such disparities. The Eunice Kennedy Shriver National Institute of Child Health and Human Development formed a community/research collaborative-the Community Child Health Network-to investigate disparities in maternal and child health in five high-risk communities. Using community participation methods, we enrolled a large cohort of African American/Black, Latino/Hispanic, and non-Hispanic/White mothers and fathers of newborns at the time of birth and followed them over 2 years. A majority had household incomes near or below the federal poverty level. Home interviews yielded detailed information regarding multiple types of stress such as major life events and many forms of chronic stress including racism. Several forms of stress varied markedly by racial/ethnic group and income, with decreasing stress as income increased among Caucasians but not among African Americans; other forms of stress varied by race/ethnicity or poverty alone. We conclude that greater sophistication in studying the many forms of stress and community partnership is necessary to uncover the mechanisms underlying health disparities in poor and ethnic-minority families and to implement community health interventions. © The Author(s) 2013.

Integrating Education on Addressing Health Disparities into the Graduate Social Work Curriculum

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Mitchell, Jamie Ann

2012-01-01

The purpose of this article is to propose an elective social work course as a means of better preparing social workers entering practice in healthcare to meet the challenges of promoting health and reducing health disparities in minority and underserved communities. Course offerings specifically targeting health or medical social work training…

Health Disparities among LGBT Older Adults and the Role of Nonconscious Bias.

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Foglia, Mary Beth; Fredriksen-Goldsen, Karen I

2014-09-01

This paper describes the significance of key empirical findings from the recent and landmark study Caring and Aging with Pride: The National Health, Aging and Sexuality Study (with Karen I. Fredriksen-Goldsen as the principal investigator), on lesbian, gay, bisexual, and transgender aging and health disparities. We will illustrate these findings with select quotations from study participants and show how nonconscious bias (i.e., activation of negative stereotypes outside conscious awareness) in the clinical encounter and health care setting can threaten shared decision-making and perpetuate health disparities among LGBT older adults. We recognize that clinical ethicists are not immune from nonconscious bias but maintain that they are well situated to recognize bias and resulting injustice by virtue of their training. Further, we discuss how clinical ethicists can influence the organization's ethical culture and environment to improve the quality and acceptability of health care for LGBT older adults. © 2014 by The Hastings Center.

Surgery, public health, and Pakistan.

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Zafar, Syed Nabeel; McQueen, K A Kelly

2011-12-01

Surgical healthcare is rapidly gaining recognition as a major public health issue. Surgical disparities are large, with poorest populations receiving the least amount of emergency and essential surgical care. In light of recent evidence, developing countries, such as Pakistan, must acknowledge surgical disease as a major public health issue and prioritize research and intervention accordingly. We review information from various sources and describe the current situation of surgical health care in Pakistan and highlight areas of neglect. Pakistan suffers an annual deficit of 17 million surgeries. Surgical disease kills more people than infectious diseases inclusive of tuberculosis, HIV/AIDS, diarrheal disease, and childhood infections. The incidence of trauma and maternal mortality ratio are staggeringly high. There is a severe dearth of surgical and anesthesia-related epidemiological data. Important information that would help to drive policy and planning is not available. Corruption and neglect have led to a dilapidated health care infrastructure. Surgical care is largely inaccessible to the poor, especially those living in rural areas. The country faces a dearth of healthcare professionals, especially paramedics, anesthetists, and surgeons. Unsafe surgery and anesthesia poses a significant risk to patients. There is no national policy on surgical illness and the preventive aspects of surgery are nonexistent. Consistent with other underdeveloped countries, surgical care in Pakistan is dismal. Neglecting surgery and safe anesthesia has led to countless deaths and disability. Physicians, researchers, policy makers, and the government health care system must engage and commit to provide access to emergency, essential, and safe surgical care.

Cancer Health Disparities Research: Where have we been and where should we go?

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Scarlett Lin Gomez, PhD, MPH, is Professor in the Department of Epidemiology and Biostatistics and a member of the Helen Diller Family Comprehensive Cancer Center at the University of California, San Francisco. She is also Director of the Greater Bay Area Cancer Registry, a part of the California Cancer Registry and the NCI Surveillance Epidemiology End Results (SEER) Program. Her research focuses primarily on cancer health disparities and aims to understand the multilevel drivers of those disparities. She has contributed surveillance data regarding cancer incidence and outcome patterns and trends for distinct Asian American, Native Hawaiian, and Pacific Islander and Hispanic ethnic groups, as well as cancer patterns by nativity status and neighborhood characteristics. She developed the California Neighborhoods Data System, a compilation of small-area level data on social and built environment characteristics, and has used these data in more than a dozen funded studies to evaluate the impact of social and built neighborhood environment factors on disease outcomes. Since 1996, Dr. Lin Gomez has received many honors and awards, including being named Author of the Year in 2010 by the American Journal of Public Health, the Above and Beyond Excellence Award in 2012 and the Mentoring Award in 2014, both by the Cancer Prevention Institute of California. She completed her education in epidemiology with an MPH at the University of Michigan, Ann Arbor, and her PhD at Stanford.

Disparity and convergence: Chinese provincial government health expenditures.

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Pan, Jay; Wang, Peng; Qin, Xuezheng; Zhang, Shufang

2013-01-01

The huge regional disparity in government health expenditures (GHE) is a major policy concern in China. This paper addresses whether provincial GHE converges in China from 1997 to 2009 using the economic convergence framework based on neoclassical economic growth theory. Our empirical investigation provides compelling evidence of long-term convergence in provincial GHE within China, but not in short-term. Policy implications of these empirical results are discussed.

Disparity and convergence: Chinese provincial government health expenditures.

Directory of Open Access Journals (Sweden)

Jay Pan

Full Text Available The huge regional disparity in government health expenditures (GHE is a major policy concern in China. This paper addresses whether provincial GHE converges in China from 1997 to 2009 using the economic convergence framework based on neoclassical economic growth theory. Our empirical investigation provides compelling evidence of long-term convergence in provincial GHE within China, but not in short-term. Policy implications of these empirical results are discussed.

National and state-specific health insurance disparities for adults in same-sex relationships.

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Gonzales, Gilbert; Blewett, Lynn A

2014-02-01

We examined national and state-specific disparities in health insurance coverage, specifically employer-sponsored insurance (ESI) coverage, for adults in same-sex relationships. We used data from the American Community Survey to identify adults (aged 25-64 years) in same-sex relationships (n = 31,947), married opposite-sex relationships (n = 3,060,711), and unmarried opposite-sex relationships (n = 259,147). We estimated multinomial logistic regression models and state-specific relative differences in ESI coverage with predictive margins. Men and women in same-sex relationships were less likely to have ESI than were their married counterparts in opposite-sex relationships. We found ESI disparities among adults in same-sex relationships in every region, but we found the largest ESI gaps for men in the South and for women in the Midwest. ESI disparities were narrower in states that had extended legal same-sex marriage, civil unions, and broad domestic partnerships. Men and women in same-sex relationships experience disparities in health insurance coverage across the country, but residing in a state that recognizes legal same-sex marriage, civil unions, or broad domestic partnerships may improve access to ESI for same-sex spouses and domestic partners.

Does Money Matter: Earnings Patterns Among a National Sample of the US State Governmental Public Health Agency Workforce.

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Castrucci, Brian C; Leider, Jonathon P; Liss-Levinson, Rivka; Sellers, Katie

2015-01-01

Earnings have been shown to be a critical point in workforce recruitment and retention. However, little is known about how much governmental public health staff are paid across the United States. To characterize earnings among state health agency central office employees. A cross-sectional survey was conducted of state health agency central office employees in late 2014. The sampling approach was stratified by 5 (paired HHS) regions. Balanced repeated replication weights were used to correctly calculate variance estimates, given the complex sampling design. Descriptive and bivariate statistical comparisons were conducted. A linear regression model was used to examine correlates of earnings among full-time employees. A total of 9300 permanently employed, full-time state health agency central office staff who reported earnings information. Earnings are the main outcomes examined in this article. Central office staff earn between $55,000 and $65,000 on average annually. Ascending supervisory status, educational attainment, and tenure are all associated with greater earnings. Those employed in clinical and laboratory positions and public health science positions earn more than their colleagues in administrative positions. Disparities exist between men and women, with men earning more, all else being equal (P earnings levels, including disparities in earnings that persist after accounting for education and experience. Data from the survey can inform strategies to address earnings issues and help reduce disparities.

Literacy disparities in patient access and health-related use of Internet and mobile technologies.

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Bailey, Stacy C; O'Conor, Rachel; Bojarski, Elizabeth A; Mullen, Rebecca; Patzer, Rachel E; Vicencio, Daniel; Jacobson, Kara L; Parker, Ruth M; Wolf, Michael S

2015-12-01

Age and race-related disparities in technology use have been well documented, but less is known about how health literacy influences technology access and use. To assess the association between patients' literacy skills and mobile phone ownership, use of text messaging, Internet access, and use of the Internet for health-related purposes. A secondary analysis utilizing data from 1077 primary care patients enrolled in two, multisite studies from 2011-2013. Patients were administered an in-person, structured interview. Patients with adequate health literacy were more likely to own a mobile phone or smartphone in comparison with patients having marginal or low literacy (mobile phone ownership: 96.8 vs. 95.2 vs. 90.1%, respectively, P Internet from their home (92.1 vs. 74.7 vs. 44.9%, P Internet for email (93.0 vs. 75.7 vs. 38.5%, P technology access and use are widespread, with lower literate patients being less likely to own smartphones or to access and use the Internet, particularly for health reasons. Future interventions should consider these disparities and ensure that health promotion activities do not further exacerbate disparities. © 2014 John Wiley & Sons Ltd.

A matter of disparities: risk groups for unhealthy lifestyle and poor health.

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Droomers, M.; Lindert, H. van; Westert, G.

2006-01-01

This chapter addresses the results of the second Dutch National Survey of General Practice (DNSGP-2) with regard to differences in health and lifestyle according to age, socio-economic status, and working status in recent years. First, disparities in health and lifestyle will be presented,

Unraveling Health Disparities Among Sexual and Gender Minorities: A Commentary on the Persistent Impact of Stigma.

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Valdiserri, Ronald O; Holtgrave, David R; Poteat, Tonia C; Beyrer, Chris

2018-01-03

LGBT (lesbian, gay, bisexual, and transgender) populations experience disparities in health outcomes, both physical and mental, compared to their heterosexual and cisgender peers. This commentary confronts the view held by some researchers that the disparate rates of mental health problems reported among LGBT populations are the consequences of pursuing a particular life trajectory, rather than resulting from the corrosive and persistent impact of stigma. Suggesting that mental health disparities among LGBT populations arise internally, de novo, when individuals express non-heterosexual and non-conforming gender identities ignores the vast body of evidence documenting the destructive impact of socially mediated stigma and systemic discrimination on health outcomes for a number of minorities, including sexual and gender minorities. Furthermore, such thinking is antithetical to widely accepted standards of health and wellbeing because it implies that LGBT persons should adopt and live out identities that contradict or deny their innermost feelings of self.

Using GIS Mapping to Target Public Health Interventions: Examining Birth Outcomes Across GIS Techniques.

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MacQuillan, E L; Curtis, A B; Baker, K M; Paul, R; Back, Y O

2017-08-01

With advances in spatial analysis techniques, there has been a trend in recent public health research to assess the contribution of area-level factors to health disparity for a number of outcomes, including births. Although it is widely accepted that health disparity is best addressed by targeted, evidence-based and data-driven community efforts, and despite national and local focus in the U.S. to reduce infant mortality and improve maternal-child health, there is little work exploring how choice of scale and specific GIS visualization technique may alter the perception of analyses focused on health disparity in birth outcomes. Retrospective cohort study. Spatial analysis of individual-level vital records data for low birthweight and preterm births born to black women from 2007 to 2012 in one mid-sized Midwest city using different geographic information systems (GIS) visualization techniques [geocoded address records were aggregated at two levels of scale and additionally mapped using kernel density estimation (KDE)]. GIS analyses in this study support our hypothesis that choice of geographic scale (neighborhood or census tract) for aggregated birth data can alter programmatic decision-making. Results indicate that the relative merits of aggregated visualization or the use of KDE technique depend on the scale of intervention. The KDE map proved useful in targeting specific areas for interventions in cities with smaller populations and larger census tracts, where they allow for greater specificity in identifying intervention areas. When public health programmers seek to inform intervention placement in highly populated areas, however, aggregated data at the census tract level may be preferred, since it requires lower investments in terms of time and cartographic skill and, unlike neighborhood, census tracts are standardized in that they become smaller as the population density of an area increases.

Secular changes in mortality disparities in New York City: a reexamination.

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Althoff, Keri N; Karpati, Adam; Hero, Joachim; Matte, Thomas D

2009-09-01

Previously published analyses showed that inequalities in mortality rates between residents of poor and wealthy neighborhoods in New York City (NYC) narrowed between 1990 and 2000, but these trends may have been influenced by population in-migration and gentrification. The NYC public housing population has been less subject to these population shifts than those in other NYC neighborhoods. We compared changes in mortality rates (MRs) from 1989-1991 to 1999-2001 among residents of NYC census blocks consisting entirely of public housing residences with residents of nonpublic housing low-income and higher-income blocks. Public housing and nonpublic housing low-income blocks were those in census block groups with > or =50% of residents living at <1.5 times the federal poverty level (FPL); nonpublic housing higher-income blocks were those in census block groups with <50% of residents living at <1.5 times the FPL. Information on deaths was obtained from NYC's vital registry, and US Census data were used for denominators. Age-standardized all-cause MRs in public housing, low-income, and higher-income residents decreased between the decades by 16%, 28%, and 22%, respectively. While mortality rate ratios between low-income and higher-income residents narrowed by 8%, the relative disparity between public housing and low-income residents widened by 21%. Diseases amenable to prevention including malignancies, diabetes, and chronic lung disease contributed to the increased overall mortality disparity between public housing and lower-income residents. These findings temper previous findings that inequalities in the health of poor and wealthier NYC neighborhood residents have narrowed. NYC public housing residents should be a high-priority population for efforts to reduce health disparities.

Eliminating Health Care Disparities With Mandatory Clinical Decision Support: The Venous Thromboembolism (VTE) Example.

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Lau, Brandyn D; Haider, Adil H; Streiff, Michael B; Lehmann, Christoph U; Kraus, Peggy S; Hobson, Deborah B; Kraenzlin, Franca S; Zeidan, Amer M; Pronovost, Peter J; Haut, Elliott R

2015-01-01

All hospitalized patients should be assessed for venous thromboembolism (VTE) risk factors and prescribed appropriate prophylaxis. To improve best-practice VTE prophylaxis prescription for all hospitalized patients, we implemented a mandatory computerized clinical decision support (CCDS) tool. The tool requires completion of checklists to evaluate VTE risk factors and contraindications to pharmacological prophylaxis, and then recommends the risk-appropriate VTE prophylaxis regimen. The objective of the study was to examine the effect of a quality improvement intervention on race-based and sex-based health care disparities across 2 distinct clinical services. This was a retrospective cohort study of a quality improvement intervention. The study included 1942 hospitalized medical patients and 1599 hospitalized adult trauma patients. In this study, the proportion of patients prescribed risk-appropriate, best-practice VTE prophylaxis was evaluated. Racial disparities existed in prescription of best-practice VTE prophylaxis in the preimplementation period between black and white patients on both the trauma (70.1% vs. 56.6%, P=0.025) and medicine (69.5% vs. 61.7%, P=0.015) services. After implementation of the CCDS tool, compliance improved for all patients, and disparities in best-practice prophylaxis prescription between black and white patients were eliminated on both services: trauma (84.5% vs. 85.5%, P=0.99) and medicine (91.8% vs. 88.0%, P=0.082). Similar findings were noted for sex disparities in the trauma cohort. Despite the fact that risk-appropriate prophylaxis should be prescribed equally to all hospitalized patients regardless of race and sex, practice varied widely before our quality improvement intervention. Our CCDS tool eliminated racial disparities in VTE prophylaxis prescription across 2 distinct clinical services. Health information technology approaches to care standardization are effective to eliminate health care disparities.

Translating Research into Policy: Reducing Breast Cancer Disparities in Illinois

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Dr. Carol Ferrans is internationally recognized for her work in disparities in health care and quality of life outcomes. She has a distinguished record of research that includes major grants funded by three institutes of the National Institutes of Health (National Cancer Institute, National Institute for Minority Health and Health Disparities, and National Institute for Nursing Research).    Dr. Ferrans’ work has been instrumental in reducing the disparity in breast cancer mortality Chicago, which at its peak was among the worst in the nation.  Efforts led by Dr. Ferrans and colleagues led directly to statewide legislation, to address the multifaceted causes of black/white disparity in deaths from breast cancer.  She was one of the founders of the Metropolitan Chicago Breast Cancer Task Force (MCBCTF), leading the team focusing on barriers to mammography screening, to identify reasons for the growing disparity in breast cancer mortality. Their findings (citing Ferrans’ research and others) and recommendations for action were translated directly into the Illinois Reducing Breast Cancer Disparities Act and two additional laws strengthening the Act.  These laws and other statewide efforts have improved access to screening and quality of mammography throughout the Illinois. In addition, Dr. Ferrans and her team identified cultural beliefs contributing to later stage diagnosis of breast cancer in African American and Latino women in Chicago, and most importantly, showed that these beliefs can be changed.  They reached more than 8,000 African American women in Chicago with a short film on DVD, which was effective in changing beliefs and promoting screening.  Her team’s published findings were cited by the American Cancer Society in their guidelines for breast cancer screening.  The Chicago black/white disparity in breast cancer deaths has decreased by 35% since the MCBCTF first released its report, according to data from the Illinois Department of Public

Mental Health Disparities Among Canadian Transgender Youth.

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Veale, Jaimie F; Watson, Ryan J; Peter, Tracey; Saewyc, Elizabeth M

2017-01-01

This study documented the prevalence of mental health problems among transgender youth in Canada and made comparisons with population-based studies. This study also compared gender identity subgroups and age subgroups (14-18 and 19-25). A nonprobability sample of 923 transgender youth from Canada completed an online survey. Participants were recruited through community organizations, health care settings, social media, and researchers' networks. Mental health measures were drawn from the British Columbia Adolescent Health Survey and the Canadian Community Health Survey. Transgender youth had a higher risk of reporting psychological distress, self-harm, major depressive episodes, and suicide. For example, 65% of transgender 14- to 18-year olds seriously considered suicide in the past year compared with 13% in the British Columbia Adolescent Health Survey, and only a quarter of participants reported their mental health was good or excellent. Transgender boys/men and nonbinary youth were most likely to report self-harm and overall mental health remained stable across age subgroups. Although a notable minority of transgender youth did not report negative health outcomes, this study shows the mental health disparities faced by transgender youth in Canada are considerable. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Obesity and Associated Health Disparities Among Understudied Multiracial, Pacific Islander, and American Indian Adults.

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Subica, Andrew M; Agarwal, Neha; Sullivan, J Greer; Link, Bruce G

2017-12-01

This study examined the state of obesity, diabetes, and associated health disparities among understudied multiracial, Native Hawaiian and Other Pacific Islander (NHOPI), and American Indian and Alaskan Native (AIAN) adults. Aggregated data for 184,617 adults from the California Health Interview Survey (2005 to 2011) were analyzed to determine obesity, diabetes, poor/fair health, and physical disability prevalence by racial group. Logistic regressions controlling for age, gender, and key social determinants (education, marital status, poverty, health insurance) generated multiracial, NHOPI, and AIAN adults' odds ratios (ORs) for our targeted health conditions versus non-Hispanic white adults. Obesity, diabetes, and other targeted health conditions were highly prevalent among multiracial, NHOPI, and AIAN adults, who displayed significantly greater adjusted odds than non-Hispanic white adults for obesity (ORs = 1.2-1.9), diabetes (ORs = 1.6-2.4), poor/fair health (ORs = 1.4-1.7), and, with the exception of NHOPI adults, physical disability (ORs = 1.5-1.6). Multiracial and AIAN adults with obesity also had significantly higher adjusted odds of diabetes (OR = 1.5-2.6) than non-Hispanic white adults with obesity. Multiracial, NHOPI, and AIAN adults experience striking obesity-related disparities versus non-Hispanic white adults, urging further disparities research with these vulnerable minority populations. © 2017 The Obesity Society.

TERRITORIAL DISPARITIES REGARDING THE DISTRIBUTION OF HEALTH SERVICE PROVIDERS IN ROMANIA AFTER JOINING THE EUROPEAN UNION STUDY CASE: MEDICAL STAFF WITH TERTIARY LEVEL OF EDUCATION

Directory of Open Access Journals (Sweden)

Babucea Ana-Gabriela

2017-02-01

Full Text Available In Romania 90ˈs, there was a relatively low level of regional disparities compared with western economies in all fields, but inequalities have emerged and widened rapidly because only certain areas, especially urban areas have benefited from inflows of capital and specialized human resources. Currently, Romania has a low level of development between EU countries, five of the eight NUTS 2 regions being the most underdeveloped in Europe. The aim of this research is a comparative analysis of developments and trends manifested in the public health system in terms of distribution of health services providers at the regional level in Romania. For the analysis of regional disparities, the research seeks to highlight a comprehensive image of the level and dynamics of the Romania territorial inequalities regarding the personnel with tertiary education, which includes physicians, dentists, and pharmaceutical chemists, as professional providers of the health services. Were took into account statistical indicators that describe the distribution of such as healthcare providers, at level of the eight Romanian NUTS2 regions, highlighting inequalities in access to health services for the population. We used available data, accessed from National Institute of Statistics of Romania, regarding Romania, and itˊs eight regions. We appeal also to statistical publications at the national and European level, other data analysis, and experts' opinions expressed in recent articles in the field. In order to identify the factors that can reduce the disparities, and ensure the equity for disadvantaged population, in terms of ensuring the health system of medical services in parallel with a homogeneous distribution of resources and services in this area, we apply specific statistics for territorial analysis and comparisons.

Racial and ethnic disparities in dental care for publicly insured children.

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Pourat, Nadereh; Finocchio, Len

2010-07-01

Poor oral health has important implications for the healthy development of children. Children in Medicaid, especially Latinos and African Americans, experience high rates of tooth decay, yet they visit dentists less often than privately insured children. Even Latino and African American children with private insurance are less likely than white children to visit dentists and have longer intervals between dental visits. Furthermore, Latino and African American children in Medicaid are more likely than white children in Medicaid to have longer intervals between visits. These findings raise concerns about Medicaid's ability to address disparities in dental care access and, more broadly, in health care.

Designing a community-based lay health advisor training curriculum to address cancer health disparities.

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Gwede, Clement K; Ashley, Atalie A; McGinnis, Kara; Montiel-Ishino, F Alejandro; Standifer, Maisha; Baldwin, Julie; Williams, Coni; Sneed, Kevin B; Wathington, Deanna; Dash-Pitts, Lolita; Green, B Lee

2013-05-01

Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. APPROACH AND STRATEGIES: Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic-community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research.

Challenges and Opportunities for Tribal Waters: Addressing Disparities in Safe Public Drinking Water on the Crow Reservation in Montana, USA.

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Doyle, John T; Kindness, Larry; Realbird, James; Eggers, Margaret J; Camper, Anne K

2018-03-21

Disparities in access to safe public drinking water are increasingly being recognized as contributing to health disparities and environmental injustice for vulnerable communities in the United States. As the Co-Directors of the Apsaálooke Water and Wastewater Authority (AWWWA) for the Crow Tribe, with our academic partners, we present here the multiple and complex challenges we have addressed in improving and maintaining tribal water and wastewater infrastructure, including the identification of diverse funding sources for infrastructure construction, the need for many kinds of specialized expertise and long-term stability of project personnel, ratepayer difficulty in paying for services, an ongoing legacy of inadequate infrastructure planning, and lack of water quality research capacity. As a tribal entity, the AWWWA faces additional challenges, including the complex jurisdictional issues affecting all phases of our work, lack of authority to create water districts, and additional legal and regulatory gaps-especially with regards to environmental protection. Despite these obstacles, the AWWWA and Crow Tribe have successfully upgraded much of the local water and wastewater infrastructure. We find that ensuring safe public drinking water for tribal and other disadvantaged U.S. communities will require comprehensive, community-engaged approaches across a broad range of stakeholders to successfully address these complex legal, regulatory, policy, community capacity, and financial challenges.

Philanthropy and disparities: progress, challenges, and unfinished business.

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Mitchell, Faith; Sessions, Kathryn

2011-10-01

Philanthropy has invested millions of dollars to reduce disparities in health care and improve minority health. Grants to strengthen providers' cultural competence, diversify health professions, and collect data have improved understanding of and spurred action on disparities. The persistence of disparities in spite of these advances has shifted philanthropic attention toward strategies to change social, economic, and environmental conditions. We argue that these evolving perspectives, along with earlier groundwork, present new opportunities for funders, especially in combination with progress toward universal health coverage. This article looks at how philanthropy has addressed health disparities over the past decade, with a focus on accomplishments, the work remaining to be done, and how funders can help advance the disparities agenda.

A Required Online Course with a Public Health Focus for Third Professional Year Pharmacy Students.

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King, Amber E; Egras, Amy M

2015-06-25

To design, deliver, and evaluate the impact of a required course on student knowledge acquisition and ability to evaluate contemporary public health issues. A 2-credit course was implemented using asynchronous, online delivery. Learning activities included literature retrieval and assessment, analytic writing, quizzes, and creation of a group wiki evaluating a current public health issue. Course topics included health care reform, social determinants of health, health disparities, evidence-based medicine, end-of-life care, patient safety, and research ethics. Strong student performance on assessments indicated an ability to use higher-order cognitive domains. Online delivery provided students with the flexibility to complete assignments at their convenience, allowed participation by all students, and encouraged self-directed learning. Completion of a required, online, asynchronous course with a public health focus allowed pharmacy students to increase their knowledge of and ability to evaluate contemporary ethical, social, cultural, and governmental issues affecting pharmacy practice.

Self-esteem and socioeconomic disparities in self-perceived oral health.

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Locker, David

2009-01-01

To determine if psychosocial factors explain the socioeconomic disparities in self-perceived oral health that persist after controlling for oral status variables. Data came from the participants in the Canadian Community Health Survey 2003 who were residents in the city of Toronto. Oral health variables included self-rated oral health, a 13-item oral health scale, denture wearing, and having a tooth extracted in the previous year. The last two measures were regarded as proxy indicators of tooth loss. Psychosocial variables included a self-esteem scale, a depression scale, and single items measuring life satisfaction, life stress, and sense of cohesion. Socioeconomic status was assessed using total annual household income. Interviews were completed with 2,754 dentate persons aged 20 years and over. Bivariate analyses confirmed that there were income gradients in self-rated oral health and scores on the oral health scale. Linear regression analyses confirmed that these persisted after controlling for age, gender, denture wearing, and having a tooth extracted in the previous year. In the model predicting self-rated oral health self-esteem, life satisfaction, stress, a sense of cohesion, and depression also contributed to the model, increased its explanatory power, and reduced the strength of but did not eliminate the association between income and self-rated oral health. Broadly, similar results were obtained when the oral health scale score was used as the dependent variable. In both analyses and all models, denture wearing had the strongest and most enduring effect. Psychosocial factors partly but do not wholly explain the socioeconomic disparities in self-perceived oral health in this population after controlling for tooth loss and denture wearing. Other variables need to be added to the models to increase their explanatory power.

Area-socioeconomic disparities in mental health service use among children involved in the child welfare system.

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Kim, Minseop; Garcia, Antonio R; Yang, Shuyan; Jung, Nahri

2018-06-01

Relying on data from a nationally representative sample of youth involved in the child welfare system (CWS) in 1999-2000 (the National Survey of Child and Adolescent Well-Being, Cohort 1) and 2008-2009 (Cohort 2), this study implemented a diverse set of disparity indicators to estimate area-socioeconomic disparities in mental health (MH) services use and changes in area-socioeconomic disparities between the two cohorts. Our study found that there are area-socioeconomic disparities in MH service use, indicating that the rates of MH service use among youth referred to the CWS differ by area-socioeconomic positions defined by county-level poverty rates. We also found that area-socioeconomic disparities increased over time. However, the magnitude of the increase varied widely across disparity measures, suggesting that there are different conclusions about the trend and magnitude of area-socioeconomic disparities, depending upon which disparity measures are implemented. A greater understanding of the methodological differences among disparity measures is warranted, which will in turn impact how interventions are designed to reduce socioeconomic disparities among children in the CWS. Copyright © 2018. Published by Elsevier Ltd.

Impact of a Population Health Management Intervention on Disparities in Cardiovascular Disease Control.

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James, Aisha; Berkowitz, Seth A; Ashburner, Jeffrey M; Chang, Yuchiao; Horn, Daniel M; O'Keefe, Sandra M; Atlas, Steven J

2018-04-01

Healthcare systems use population health management programs to improve the quality of cardiovascular disease care. Adding a dedicated population health coordinator (PHC) who identifies and reaches out to patients not meeting cardiovascular care goals to these programs may help reduce disparities in cardiovascular care. To determine whether a program that used PHCs decreased racial/ethnic disparities in LDL cholesterol and blood pressure (BP) control. Retrospective difference-in-difference analysis. Twelve thousdand five hundred fifty-five primary care patients with cardiovascular disease (cohort for LDL analysis) and 41,183 with hypertension (cohort for BP analysis). From July 1, 2014-December 31, 2014, 18 practices used an information technology (IT) system to identify patients not meeting LDL and BP goals; 8 practices also received a PHC. We examined whether having the PHC plus IT system, compared with having the IT system alone, decreased racial/ethnic disparities, using difference-in-difference analysis of data collected before and after program implementation. Meeting guideline concordant LDL and BP goals. At baseline, there were racial/ethnic disparities in meeting LDL (p = 0.007) and BP (p = 0.0003) goals. Comparing practices with and without a PHC, and accounting for pre-intervention LDL control, non-Hispanic white patients in PHC practices had improved odds of LDL control (OR 1.20 95% CI 1.09-1.32) compared with those in non-PHC practices. Non-Hispanic black (OR 1.15 95% CI 0.80-1.65) and Hispanic (OR 1.29 95% CI 0.66-2.53) patients saw similar, but non-significant, improvements in LDL control. For BP control, non-Hispanic white patients in PHC practices (versus non-PHC) improved (OR 1.13 95% CI 1.05-1.22). Non-Hispanic black patients (OR 1.17 95% CI 0.94-1.45) saw similar, but non-statistically significant, improvements in BP control, but Hispanic (OR 0.90 95% CI 0.59-1.36) patients did not. Interaction testing confirmed that disparities did not

Selected preconception health indicators and birth weight disparities in a national study.

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Strutz, Kelly L; Richardson, Liana J; Hussey, Jon M

2014-01-01

This analysis explored the effect of timing, sequencing, and change in preconception health across adolescence and young adulthood on racial/ethnic disparities in birth weight in a diverse national cohort of young adult women. Data came from Waves I (1994-1995), III (2001-2002), and IV (2007-2008) of the National Longitudinal Study of Adolescent Health. Eligibility was restricted to all singleton live births to female non-Hispanic White, non-Hispanic Black, Mexican-origin Latina, or Asian/Pacific Islander participants (n = 3,014) occurring between the Wave III (ages 18-26 years) and IV (ages 24-32 years) interviews. Birth weight was categorized into low (4,000 g). Preconception health indicators were cigarette smoking, heavy alcohol consumption, overweight or obesity, and inadequate physical activity, measured in adolescence (Wave I, ages 11-19 years) and early adulthood (Wave III) and combined into four-category variables to capture the timing and sequencing of exposure. Measures of preconception health did not explain the Black-White disparity in low birth weight, which increased after adjustment for confounders (odds ratio [OR], 2.17; 95% confidence interval [CI], 1.33-3.53) and effect modification by overweight/obesity (OR, 3.58; 95% CI, 1.65-7.78). A positive association between adult-onset overweight/obesity and macrosomia was modified by race (OR, 3.83; 95% CI, 1.02-14.36 for Black women). This longitudinal analysis provides new evidence on preconception health and racial/ethnic disparities in birth weight. Specifically, it indicates that interventions focused on prevention of overweight/obesity and maintenance of healthy weight during the transition to adulthood, especially among Black females, may be warranted. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Closing the quality gap: revisiting the state of the science (vol. 3: quality improvement interventions to address health disparities).

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McPheeters, Melissa L; Kripalani, Sunil; Peterson, Neeraja B; Idowu, Rachel T; Jerome, Rebecca N; Potter, Shannon A; Andrews, Jeffrey C

2012-08-01

This review evaluates the effectiveness of quality improvement (QI) strategies in reducing disparities in health and health care. We identified papers published in English between 1983 and 2011 from the MEDLINE® database, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science Social Science Index, and PsycINFO. All abstracts and full-text articles were dually reviewed. Studies were eligible if they reported data on effectiveness of QI interventions on processes or health outcomes in the United States such that the impact on a health disparity could be measured. The review focused on the following clinical conditions: breast cancer, colorectal cancer, diabetes, heart failure, hypertension, coronary artery disease, asthma, major depressive disorder, cystic fibrosis, pneumonia, pregnancy, and end-stage renal disease. It assessed health disparities associated with race or ethnicity, socioeconomic status, insurance status, sexual orientation, health literacy/numeracy, and language barrier. We evaluated the risk of bias of individual studies and the overall strength of the body of evidence based on risk of bias, consistency, directness, and precision. Nineteen papers, representing 14 primary research studies, met criteria for inclusion. All but one of the studies incorporated multiple components into their QI approach. Patient education was part of most interventions (12 of 14), although the specific approach differed substantially across the studies. Ten of the studies incorporated self-management; this would include, for example, teaching individuals with diabetes to check their blood sugar regularly. Most (8 of 14) included some sort of provider education, which may have focused on the clinical issue or on raising awareness about disparities affecting the target population. Studies evaluated the effect of these strategies on disparities in the prevention or treatment of breast or colorectal cancer, cardiovascular disease, depression, or

Health Disparities by Income in Spain Before and After the Economic Crisis.

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Coveney, Max; García-Gómez, Pilar; Van Doorslaer, Eddy; Van Ourti, Tom

2016-11-01

Little is known about how health disparities by income change during times of economic crisis. We apply a decomposition method to unravel the contributions of income growth, income inequality and differential income mobility across socio-demographic groups to changes in health disparities by income in Spain using longitudinal data from the Survey of Income and Living Conditions for the period 2004-2012. We find a modest rise in health inequality by income in Spain in the 5 years of economic growth prior to the start of the crisis in 2008, but a sharp fall after 2008. The drop mainly derives from the fact that loss of employment and earnings has disproportionately affected the incomes of the younger and healthier groups rather than the (mainly stable pension) incomes of the groups over 65 years. This suggests that unequal distribution of income protection by age may reduce health inequality in the short run after an economic recession. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Disparities in Oral Health

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... Private Wells Infant Formula Fluorosis Public Health Service Recommendation Water Operators & Engineers Water Fluoridation Additives Shortages of Fluoridation Additives Drinking Water Pipe Systems CDC-Sponsored Water Fluoridation Training Links to Other ...

Let's not contribute to disparities: the best methods for teaching clinicians how to overcome language barriers to health care.

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Diamond, Lisa C; Jacobs, Elizabeth A

2010-05-01

Clinicians should be educated about how language barriers contribute to disparities for patients with limited English proficiency (LEP). However, educators must avoid developing educational interventions that increase health disparities for LEP patients. For example, studies suggest that teaching "Medical Spanish" or related courses may actually contribute to health care disparities if clinicians begin using these non-English language skills inappropriately with patients. We discuss the risks and benefits of teaching specific cultural competence skills and make evidence-based recommendations for the teaching content and methods for educational interventions focused on overcoming language barriers in health care. At minimum, we suggest such interventions include: (1) the role of language barriers in health disparities, (2) means of overcoming language barriers, (3) how to work with interpreters, (4) identifying and fixing problems in interpreted encounters, and (5) appropriate and safe use of one's own limited non-English language skills.

Unintended effects of emphasizing disparities in cancer communication to African-Americans.

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Nicholson, Robert A; Kreuter, Matthew W; Lapka, Christina; Wellborn, Rachel; Clark, Eddie M; Sanders-Thompson, Vetta; Jacobsen, Heather M; Casey, Chris

2008-11-01

Little is known about how minority groups react to public information that highlights racial disparities in cancer. This double-blind randomized study compared emotional and behavioral reactions to four versions of the same colon cancer (CRC) information presented in mock news articles to a community sample of African-American adults (n = 300). Participants read one of four articles that varied in their framing and interpretation of race-specific CRC mortality data, emphasizing impact (CRC is an important problem for African-Americans), two dimensions of disparity (Blacks are doing worse than Whites and Blacks are improving, but less than Whites), or progress (Blacks are improving over time). Participants exposed to disparity articles reported more negative emotional reactions to the information and were less likely to want to be screened for CRC than those in other groups (both P emotional reactions and participants were more likely to want to be screened. Moreover, negative emotional reaction seemed to mediate the influence of message type on individuals wanting to be screened for CRC. Overall, these results suggest that the way in which disparity research is reported in the medium can influence public attitudes and intentions, with reports about progress yielding a more positive effect on intention. This seems especially important among those with high levels of medical mistrust who are least likely to use the health care system and are thus the primary target of health promotion advertising.

Rural-urban disparities in child nutrition in Bangladesh and Nepal.

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Srinivasan, Chittur S; Zanello, Giacomo; Shankar, Bhavani

2013-06-14

major share of rural-urban disparities in the lowest quantiles of child nutrition outcomes. Differences in the strength of association between socio-economic characteristics and child nutrition outcomes account for less than a quarter of rural-urban disparities at the lower end of the HAZ score distribution. Public health interventions aimed at overcoming rural-urban disparities in child nutrition outcomes need to focus principally on bridging gaps in socio-economic endowments of rural and urban households and improving the quality of rural infrastructure. Improving child nutrition outcomes in developing countries does not call for fundamentally different approaches to public health interventions in rural and urban areas.

A participatory evaluation framework in the establishment and implementation of transdisciplinary collaborative centers for health disparities research.

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Scarinci, Isabel C; Moore, Artisha; Benjamin, Regina; Vickers, Selwyn; Shikany, James; Fouad, Mona

2017-02-01

We describe the formulation and implementation of a participatory evaluation plan for three Transdisciplinary Collaborative Centers for Health Disparities Research funded by the National Institute of Minority Health and Health Disparities. Although different in scope of work, all three centers share a common goal of establishing sustainable centers in health disparities science in three priority areas - social determinants of health, men's health research, and health policy research. The logic model guides the process, impact, and outcome evaluation. Emphasis is placed on process evaluation in order to establish a "blue print" that can guide other efforts as well as assure that activities are being implemented as planned. We have learned three major lessons in this process: (1) Significant engagement, participation, and commitment of all involved is critical for the evaluation process; (2) Having a "roadmap" (logic model) and "directions" (evaluation worksheets) are instrumental in getting members from different backgrounds to follow the same path; and (3) Participation of the evaluator in the leadership and core meetings facilitates continuous feedback. Copyright © 2016 Elsevier Ltd. All rights reserved.

Health disparities between lesbian, gay, and bisexual adults and the general population in South Korea: Rainbow Connection Project I

Directory of Open Access Journals (Sweden)

Horim Yi

2017-10-01

Full Text Available OBJECTIVES This study aims to investigate health disparities between lesbian, gay, and bisexual (LGB adults and the general population in Korea, where there is low public acceptance of sexual minorities and a lack of research on the health of sexual minorities. METHODS The research team conducted a nationwide survey of 2,335 Korean LGB adults in 2016. Using the dataset, we estimated the age-standardized prevalence ratios (SPRs for poor self-rated health, musculoskeletal pain, depressive symptoms, suicidal behaviors, smoking, and hazardous drinking. We then compared the SPRs of the LGB adults and the general population which participated in three different nationally representative surveys in Korea. SPRs were estimated for each of the four groups (i.e., gay men, bisexual men, lesbians, and bisexual women. RESULTS Korean LGB adults exhibited a statistically significantly higher prevalence of depressive symptoms, suicidal ideation and attempts, and musculoskeletal pain than the general population. Lesbian and bisexual women had a higher risk of poor self-rated health and smoking than the general women population, whereas gay and bisexual men showed no differences with the general men population. Higher prevalence of hazardous drinking was observed among lesbians, gay men, and bisexual women compared to the general population, but was not observed in bisexual men. CONCLUSIONS The findings suggest that LGB adults have poorer health conditions compared to the general population in Korea. These results suggest that interventions are needed to address the health disparities of Korean LGB adults.

Health disparities between lesbian, gay, and bisexual adults and the general population in South Korea: Rainbow Connection Project I.

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Yi, Horim; Lee, Hyemin; Park, Jooyoung; Choi, Bokyoung; Kim, Seung-Sup

2017-01-01

This study aims to investigate health disparities between lesbian, gay, and bisexual (LGB) adults and the general population in Korea, where there is low public acceptance of sexual minorities and a lack of research on the health of sexual minorities. The research team conducted a nationwide survey of 2,335 Korean LGB adults in 2016. Using the dataset, we estimated the age-standardized prevalence ratios (SPRs) for poor self-rated health, musculoskeletal pain, depressive symptoms, suicidal behaviors, smoking, and hazardous drinking. We then compared the SPRs of the LGB adults and the general population which participated in three different nationally representative surveys in Korea. SPRs were estimated for each of the four groups (i.e., gay men, bisexual men, lesbians, and bisexual women). Korean LGB adults exhibited a statistically significantly higher prevalence of depressive symptoms, suicidal ideation and attempts, and musculoskeletal pain than the general population. Lesbian and bisexual women had a higher risk of poor self-rated health and smoking than the general women population, whereas gay and bisexual men showed no differences with the general men population. Higher prevalence of hazardous drinking was observed among lesbians, gay men, and bisexual women compared to the general population, but was not observed in bisexual men. The findings suggest that LGB adults have poorer health conditions compared to the general population in Korea. These results suggest that interventions are needed to address the health disparities of Korean LGB adults.

Racial Disparities in Health Behaviors and Conditions Among Lesbian and Bisexual Women: The Role of Internalized Stigma

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Molina, Yamile; Lehavot, Keren; Beadnell, Blair; Simoni, Jane

2013-01-01

There are documented disparities in physical health behaviors and conditions, such as physical activity and obesity, with regard to both race/ethnicity and sexual orientation. However, physical health disparities for lesbian and bisexual (LB) women who are also racial minorities are relatively unexplored. Minority stressors, such as internalized stigma, may account for disparities in such multiply marginalized populations. We sought to (1) characterize inequalities among non-Hispanic white and African American LB women and (2) examine the roles of internalized sexism and homophobia in disparities. Data on health behaviors (diet, physical activity); physical health (hypertension, diabetes, overweight/obesity); internalized sexism; and internalized homophobia were collected via a web-based survey. Recruitment ads were sent electronically to over 200 listservs, online groups, and organizations serving the lesbian, gay, and bisexual community in all 50 U.S. states. The analytic sample consisted of 954 white and 75 African American LB women. African American participants were more likely than white participants to report low fruit/vegetable intake and physical activity, a higher body mass index, and a history of diabetes and hypertension. There were no racial differences in internalized homophobia, but African American women reported higher levels of internalized sexism. Internalized sexism partially mediated racial disparities in physical activity and diabetes, but not in the other outcomes. Findings suggest that African American LB women may be at greater risk than their white counterparts for poor health and that internalized sexism may be a mediator of racial differences for certain behaviors and conditions. PMID:25364769

Lifecourse approach to racial/ethnic disparities in childhood obesity.

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Dixon, Brittany; Peña, Michelle-Marie; Taveras, Elsie M

2012-01-01

Eliminating racial/ethnic disparities in health and health care is a national priority, and obesity is a prime target. During the last 30 y in the United States, the prevalence of obesity among children has dramatically increased, sparing no age group. Obesity in childhood is associated with adverse cardio-metabolic outcomes such as hypertension, hyperlipidemia, and type II diabetes and with other long-term adverse outcomes, including both physical and psychosocial consequences. By the preschool years, racial/ethnic disparities in obesity prevalence are already present, suggesting that disparities in childhood obesity prevalence have their origins in the earliest stages of life. Several risk factors during pregnancy are associated with increased risk of offspring obesity, including excessive maternal gestational weight gain, gestational diabetes, smoking during pregnancy, antenatal depression, and biological stress. During infancy and early childhood, rapid infant weight gain, infant feeding practices, sleep duration, child's diet, physical activity, and sedentary practices are associated with the development of obesity. Studies have found substantial racial/ethnic differences in many of these early life risk factors for childhood obesity. It is possible that racial/ethnic differences in early life risk factors for obesity might contribute to the high prevalence of obesity among minority preschool-age children and beyond. Understanding these differences may help inform the design of clinical and public health interventions and policies to reduce the prevalence of childhood obesity and eliminate disparities among racial/ethnic minority children.

Psychosocial Effects of Health Disparities of Lesbian, Gay, Bisexual, and Transgender Older Adults.

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Zelle, Andraya; Arms, Tamatha

2015-07-01

The 1.5 million older adults who self-identify as lesbian, gay, bisexual, and transgender (LGBT) are expected to double in number by 2030. Research suggests that health disparities are closely linked with societal stigma, discrimination, and denial of civil and human rights. More LGBT older adults struggle with depression, substance abuse, social isolation, and acceptance compared to their heterosexual counterparts. Despite individual preferences, most health care providers recognize the right of any individual to have access to basic medical services. The U.S. Department of Health and Human Services requires that all hospitals receiving funds from Medicare and Medicaid respect visitation and medical decision-making rights to all individuals identifying as LGBT. The Joint Commission also requires a non-discrimination statement for accreditation. The current literature review examines LGBT health disparities and the consequential psychosocial impact on LGBT older adults as well as brings awareness to the needs of this underserved and underrepresented population. Copyright 2015, SLACK Incorporated.

Student learning outcomes associated with video vs. paper cases in a public health dentistry course.

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Chi, Donald L; Pickrell, Jacqueline E; Riedy, Christine A

2014-01-01

Educational technologies such as video cases can improve health professions student learning outcomes, but few studies in dentistry have evaluated video-based technologies. The goal of this study was to compare outcomes associated with video and paper cases used in an introductory public health dentistry course. This was a retrospective cohort study with a historical control group. Based on dual coding theory, the authors tested the hypotheses that dental students who received a video case (n=37) would report better affective, cognitive, and overall learning outcomes than students who received a paper case (n=75). One-way ANOVA was used to test the hypotheses across ten cognitive, two affective, and one general assessment measures (α=0.05). Students in the video group reported a significantly higher overall mean effectiveness score than students in the paper group (4.2 and 3.3, respectively; p<0.001). Video cases were also associated with significantly higher mean scores across the remaining twelve measures and were effective in helping students achieve cognitive (e.g., facilitating good discussions, identifying public health problems, realizing how health disparities might impact their future role as dentists) and affective (e.g., empathizing with vulnerable individuals, appreciating how health disparities impact real people) goals. Compared to paper cases, video cases significantly improved cognitive, affective, and overall learning outcomes for dental students.

Social support and depressive symptom disparity between urban and rural older adults in China.

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Hu, Hongwei; Cao, Qi; Shi, Zhenzhen; Lin, Weixia; Jiang, Haixia; Hou, Yucheng

2018-09-01

Depressive symptom disparity between urban and rural older adults is an important public health issue in China. Social support is considered as an effective way to alleviate depression of older adults. This study aimed to investigate the extent to which social support could explain the depressive symptom disparity between urban and rural older adults in China. This study used data drawn from the 2011 China Health and Retirement Longitudinal Study with 6,772 observations. Multiple data analysis strategies were adopted, including descriptive analyses, bivariate analyses, regression analyses and decomposition analyses. There were significant depressive symptom disparities between urban and rural older adults in China. Social support had significant association with depressive symptom of older adults while adjusting for covariates. About 25%-28% of the depressive symptom disparities could be attributed to urban-rural gaps in social support, in which community support contributed 21%-25%. Educational level and physical health status also contributed to the disparities. This study only established correlations between social support and depressive symptom disparity rather than casual relationships; and the self-reported measurement of depressive symptom and the unobservable cultural factors might cause limitations. The urban-rural gap in social support, especially community support was a prime explanation for depressive symptom disparities between urban and rural older adults in China. To reduce the depressive symptom disparities, effective community construction in rural China should be put into place, including improving the infrastructure construction, strengthening the role of social organizations, and encouraging community interpersonal interactions for older adults. Copyright © 2018 Elsevier B.V. All rights reserved.

[Health services research for the public health service (PHS) and the public health system].

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Hollederer, A; Wildner, M

2015-03-01

There is a great need for health services research in the public health system and in the German public health service. However, the public health service is underrepresented in health services research in Germany. This has several structural, historical and disciplinary-related reasons. The public health service is characterised by a broad range of activities, high qualification requirements and changing framework conditions. The concept of health services research is similar to that of the public health service and public health system, because it includes the principles of multidisciplinarity, multiprofessionalism and daily routine orientation. This article focuses on a specified system theory based model of health services research for the public health system and public health service. The model is based on established models of the health services research and health system research, which are further developed according to specific requirements of the public health service. It provides a theoretical foundation for health services research on the macro-, meso- and microlevels in public health service and the public health system. Prospects for public health service are seen in the development from "old public health" to "new public health" as well as in the integration of health services research and health system research. There is a significant potential for development in a better linkage between university research and public health service as is the case for the "Pettenkofer School of Public Health Munich". © Georg Thieme Verlag KG Stuttgart · New York.

Disparities in the use of preventive health care among children with disabilities in Taiwan.

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Tsai, Wen-Chen; Kung, Pei-Tseng; Wang, Jong-Yi

2012-01-01

Children with disabilities face more barriers accessing preventive health services. Prior research has documented disparities in the receipt of these services. However, most are limited to specific types of disability or care. This study investigates disparities in the use of preventive health care among children with disabilities in Taiwan. Three nationwide databases from the Ministry of the Interior, Bureau of Health Promotion, and National Health Research Institutes were linked to gather related information between 2006 and 2008. A total of 8572 children with disabilities aged 1-7 years were included in this study. Multivariate logistic regression analysis was conducted to adjust for covariates. Nationally, only 37.58% of children with disabilities received preventive health care in 2008. Children with severe and very severe disabilities were less likely to use preventive care than those with mild severity. Children with disabilities from the lowest income family were less likely to have preventive care than other income groups. Urbanization was strongly associated with the receipt of preventive health care. However, surprisingly, urban children with disabilities were less likely to receive preventive care than all others. Under universal health insurance coverage, the overall usage of preventive health care is still low among children with disabilities. The study also identified several disparities in their usage. Potential factors affecting the lack of use deserve additional research. Policymakers should target low socioeconomic brackets and foster education about the importance of preventive care. Mobile health services should be continually provided in those areas in need. Capitation reimbursement and other incentives should be considered in improving the utilization among children with disabilities. Copyright © 2011 Elsevier Ltd. All rights reserved.

Applying anthropology to eliminate tobacco-related health disparities.

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Goldade, Kate; Burgess, Diana; Olayinka, Abimbola; Whembolua, Guy Lucien S; Okuyemi, Kolawole S

2012-06-01

Disparities in tobacco's harm persist. Declines in smoking among the general population have not been experienced to the same extent by vulnerable populations. Innovative strategies are required to diminish disparities in tobacco's harm. As novel tools, anthropological concepts and methods may be applied to improve the design and outcomes of tobacco cessation interventions. We reviewed over 60 articles published in peer-reviewed journals since 1995 for content on anthropology and smoking cessation. The specific questions framing the review were: (a) "How can lessons learned from anthropological studies of smoking improve the design and effectiveness of smoking cessation interventions?" (b) How can anthropology be applied to diminish disparities in smoking cessation? and (c) How can qualitative methods be used most effectively in smoking cessation intervention research? Three specific disciplinary tools were identified and examined: (a) culture, (b) reflexivity, and (c) qualitative methods. Examining culture as a dynamic influence and understanding the utilities of smoking in a particular group is a precursor to promoting cessation. Reflexivity enables a deeper understanding of how smokers perceive quitting and smoking beyond addiction and individual health consequences. Qualitative methods may be used to elicit in-depth perspectives on quitting, insights to inform existing community-based strategies for making behavior changes, and detailed preferences for cessation treatment or programs. Anthropological tools can be used to improve the effectiveness of intervention research studies targeting individuals from vulnerable groups. Synthesized applications of anthropological concepts can be used to facilitate translation of findings into clinical practice for providers addressing tobacco cessation in vulnerable populations.

Healthcare disparities in critical illness.

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Soto, Graciela J; Martin, Greg S; Gong, Michelle Ng

2013-12-01

To summarize the current literature on racial and gender disparities in critical care and the mechanisms underlying these disparities in the course of acute critical illness. MEDLINE search on the published literature addressing racial, ethnic, or gender disparities in acute critical illness, such as sepsis, acute lung injury, pneumonia, venous thromboembolism, and cardiac arrest. Clinical studies that evaluated general critically ill patient populations in the United States as well as specific critical care conditions were reviewed with a focus on studies evaluating factors and contributors to health disparities. Study findings are presented according to their association with the prevalence, clinical presentation, management, and outcomes in acute critical illness. This review presents potential contributors for racial and gender disparities related to genetic susceptibility, comorbidities, preventive health services, socioeconomic factors, cultural differences, and access to care. The data are organized along the course of acute critical illness. The literature to date shows that disparities in critical care are most likely multifactorial involving individual, community, and hospital-level factors at several points in the continuum of acute critical illness. The data presented identify potential targets as interventions to reduce disparities in critical care and future avenues for research.

Disparities in health in the United States: An overview of the social determinants of health for otolaryngologists.

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Bergmark, Regan W; Sedaghat, Ahmad R

2017-08-01

Social determinants of health include social and demographic factors such as poverty, education status, race and ethnicity, gender, insurance status, and other factors that influence (1) development of illness, (2) ability to obtain and utilize healthcare, and (3) health and healthcare outcomes. In otolaryngology, as in other subspecialty surgical fields, we are constantly confronted by patients' social and demographic circumstances including poverty, language barriers, and lack of health insurance and yet there is limited research on how these factors impact health equity in our field, or how attention to these patient characteristics may improve health equity. This review provides the reader with a framework to understand the social determinants of health including how socioeconomic status, insurance status, race, gender, and other factors impact health. Foundational papers on the social determinants of health are reviewed, as well as otolaryngology publications focused on health and healthcare disparities. The social determinants of health have a major impact on patient health as well as healthcare utilization, but there is a relative lack of data on these factors and how they can be addressed within otolaryngology. Incorporating tools to measure social and demographic characteristics and actually report on these measures is a first simple step to increase the data on the social determinants of health as they pertain to otolaryngology. More research is needed on the social determinants of health, and how they impact otolaryngic disease. Medicare's Accountable Care Organization models will increasingly change the way in which physicians are reimbursed, making the social determinants of health central not only to our moral conscience but also the bottom line. 4.

Take Action to Decrease Your Cancer Risk - Obesity and Its Role in Cancer Health Disparities

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In support of this year’s National Minority Health Month theme “Prevention is Power: Taking Action for Health Equity!”, CRCHD is highlighting the role of obesity in cancer health disparities among diverse population groups in the U.S.

Exploring disparities in prenatal care between refugees and local South African women.

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Kibiribiri, Edith T; Moodley, Dhayendre; Groves, Allison K; Sebitloane, Motshedisi H

2016-02-01

To explore possible disparities in prenatal care between refugees and South African women attending public health facilities in an urban setting in South Africa. A cross-sectional, mixed methods study was conducted at four public health clinics providing prenatal services in Durban between January 29, 2013, and June 15, 2013. Pretested client-satisfaction questionnaires were administered to 200 women attending immunization services at the clinics whose infants were aged 6 months or younger. An additional 16 refugees participated in in-depth interviews. Finally, a maternity chart audit was conducted to compare the quality of basic prenatal care. Among the women enrolled, 78 (39.0%) were refugees and 122 (61.0%) were South African citizens. Dissatisfaction was reported by 23 (19.3%) of 119 citizens and 32 (43.2%) of 74 refugees (Prefugees, 37 citizens) did not reveal significant disparities in the quality of prenatal care. The most recurring categories arising in the in-depth interviews were linguistic barriers and the challenges faced when using informal interpreters. There were no significant disparities in prenatal care; however, refugees unable to communicate in the local languages reported that they were not provided with relevant health information and occasionally faced restricted access to prenatal services. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Reducing Ex-offender Health Disparities through the Affordable Care Act: Fostering Improved Health Care Access and Linkages to Integrated Care

Directory of Open Access Journals (Sweden)

Lacreisha Ejike-King

2014-04-01

Full Text Available Despite steadily declining incarceration rates overall, racial and ethnic minorities, namely African Americans, Latinos, and American Indians and Alaska Natives, continue to be disproportionately represented in the justice system. Ex-offenders commonly reenter communities with pressing health conditions but encounter obstacles to accessing care and remaining in care. The lack of health insurance coverage and medical treatment emerge as the some of the most reported reentry health needs and may contribute to observed health disparities. Linking ex-offenders to care and services upon release increases the likelihood that they will remain in care and practice successful disease management. The Affordable Care Act (ACA offers opportunities to address health disparities experienced by the reentry population that places them at risk for negative health outcomes and recidivism. Coordinated efforts to link ex-offenders with these newly available opportunities may result in a trajectory for positive health and overall well-being as they reintegrate into society.

Racial Ethnic Health Disparities: A Phenomenological Exploration of African American with Diabetes Complications

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Okombo, Florence A.

2017-01-01

Racial/ethnic minority groups experience a higher mortality rate, a lower life expectancy, and worse mental health outcomes than non-Hispanic in the United States. There is a scarcity of qualitative studies on racial/ethnic health disparities. The purpose of this hermeneutic phenomenological study was to explore the personal experiences,…

Awareness of Racial Disparities in Kidney Transplantation among Health Care Providers in Dialysis Facilities.

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Kim, Joyce J; Basu, Mohua; Plantinga, Laura; Pastan, Stephen O; Mohan, Sumit; Smith, Kayla; Melanson, Taylor; Escoffery, Cam; Patzer, Rachel E

2018-05-07

Despite the important role that health care providers at dialysis facilities have in reducing racial disparities in access to kidney transplantation in the United States, little is known about provider awareness of these disparities. We aimed to evaluate health care providers' awareness of racial disparities in kidney transplant waitlisting and identify factors associated with awareness. We conducted a cross-sectional analysis of a survey of providers from low-waitlisting dialysis facilities ( n =655) across all 18 ESRD networks administered in 2016 in the United States merged with 2014 US Renal Data System and 2014 US Census data. Awareness of national racial disparity in waitlisting was defined as responding "yes" to the question: "Nationally, do you think that African Americans currently have lower waitlisting rates than white patients on average?" The secondary outcome was providers' perceptions of racial difference in waitlisting at their own facilities. Among 655 providers surveyed, 19% were aware of the national racial disparity in waitlisting: 50% (57 of 113) of medical directors, 11% (35 of 327) of nurse managers, and 16% (35 of 215) of other providers. In analyses adjusted for provider and facility characteristics, nurse managers (versus medical directors; odds ratio, 7.33; 95% confidence interval, 3.35 to 16.0) and white providers (versus black providers; odds ratio, 2.64; 95% confidence interval, 1.39 to 5.02) were more likely to be unaware of a national racial disparity in waitlisting. Facilities in the South (versus the Northeast; odds ratio, 3.05; 95% confidence interval, 1.04 to 8.94) and facilities with a low percentage of blacks (versus a high percentage of blacks; odds ratio, 1.86; 95% confidence interval, 1.02 to 3.39) were more likely to be unaware. One quarter of facilities had >5% racial difference in waitlisting within their own facilities, but only 5% were aware of the disparity. Among a limited sample of dialysis facilities with low

Reducing Cancer Health Disparities through Community Engagement: Working with Faith-Based Organizations (Project CHURCH) | Division of Cancer Prevention

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Speaker | "Reducing Cancer Health Disparities through Community Engagement: Working with Faith-Based Organizations (Project CHURCH)" will be presented by Lorna H. McNeill, PhD, MPH, Chair of the Department of Health Disparities at the University of Texas MD Anderson Cancer Center in Houston, TX. Date: 2/20/2018; Time: 11:00am - 12:00pm; Location: NCI Shady Grove Campus,

Ethnic disparities in children's oral health: findings from a population-based survey of grade 1 and 2 schoolchildren in Alberta, Canada.

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Shi, Congshi; Faris, Peter; McNeil, Deborah A; Patterson, Steven; Potestio, Melissa L; Thawer, Salima; McLaren, Lindsay

2018-01-04

Although oral health has improved remarkably in recent decades, not all populations have benefited equally. Ethnic identity, and in particular visible minority status, has been identified as an important risk factor for poor oral health. Canadian research on ethnic disparities in oral health is extremely limited. The aim of this study was to examine ethnic disparities in oral health outcomes and to assess the extent to which ethnic disparities could be accounted for by demographic, socioeconomic and caries-related behavioral factors, among a population-based sample of grade 1 and 2 schoolchildren (age range: 5-8 years) in Alberta, Canada. A dental survey (administered during 2013-14) included a mouth examination and parent questionnaire. Oral health outcomes included: 1) percentage of children with dental caries; 2) number of decayed, extracted/missing (due to caries) and filled teeth; 3) percentage of children with two or more teeth with untreated caries; and 4) percentage of children with parental-ratings of fair or poor oral health. We used multivariable regression analysis to examine ethnic disparities in oral health, adjusting for demographic, socioeconomic and caries-related behavioral variables. We observed significant ethnic disparities in children's oral health. Most visible minority groups, particularly Filipino and Arab, as well as Indigenous children, were more likely to have worse oral health than White populations. In particular, Filipino children had an almost 5-fold higher odds of having severe untreated dental problems (2 or more teeth with untreated caries) than White children. Adjustment for demographic, socioeconomic, and caries-related behavior variables attenuated but did not eliminate ethnic disparities in oral health, with the exception of Latin American children whose outcomes did not differ significantly from White populations after adjustment. Significant ethnic disparities in oral health exist in Alberta, Canada, even when adjusting for

Implementation of Local Wellness Policies in Schools: Role of School Systems, School Health Councils, and Health Disparities.

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Hager, Erin R; Rubio, Diana S; Eidel, G Stewart; Penniston, Erin S; Lopes, Megan; Saksvig, Brit I; Fox, Renee E; Black, Maureen M

2016-10-01

Written local wellness policies (LWPs) are mandated in school systems to enhance opportunities for healthy eating/activity. LWP effectiveness relies on school-level implementation. We examined factors associated with school-level LWP implementation. Hypothesized associations included system support for school-level implementation and having a school-level wellness team/school health council (SHC), with stronger associations among schools without disparity enrollment (majority African-American/Hispanic or low-income students). Online surveys were administered: 24 systems (support), 1349 schools (LWP implementation, perceived system support, SHC). The state provided school demographics. Analyses included multilevel multinomial logistic regression. Response rates were 100% (systems)/55.2% (schools). Among schools, 44.0% had SHCs, 22.6% majority (≥75%) African-American/Hispanic students, and 25.5% majority (≥75%) low-income (receiving free/reduced-price meals). LWP implementation (17-items) categorized as none = 36.3%, low (1-5 items) = 36.3%, high (6+ items) = 27.4%. In adjusted models, greater likelihood of LWP implementation was observed among schools with perceived system support (high versus none relative risk ratio, RRR = 1.63, CI: 1.49, 1.78; low versus none RRR = 1.26, CI: 1.18, 1.36) and SHCs (high versus none RRR = 6.8, CI: 4.07, 11.37; low versus none RRR = 2.24, CI: 1.48, 3.39). Disparity enrollment did not moderate associations (p > .05). Schools with perceived system support and SHCs had greater likelihood of LWP implementation, with no moderating effect of disparity enrollment. SHCs/support may overcome LWP implementation obstacles related to disparities. © 2016, American School Health Association.

Health Insurance Disparities among Immigrants: Are Some Legal Immigrants More Vulnerable than Others?

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Pandey, Shanta; Kagotho, Njeri

2010-01-01

This study examined health insurance disparities among recent immigrants. The authors analyzed all working-age adult immigrants between the ages of 18 and 64 using the New Immigrant Survey data collected in 2003. This survey is a cross-sectional interview of recent legal permanent residents on their social, economic, and health status. Respondents…

Spatial accessibility to basic public health services in South Sudan

Directory of Open Access Journals (Sweden)

Peter M. Macharia

2017-05-01

Full Text Available At independence in 2011, South Sudan’s health sector was almost non-existent. The first national health strategic plan aimed to achieve an integrated health facility network that would mean that 70% of the population were within 5 km of a health service provider. Publically available data on functioning and closed health facilities, population distribution, road networks, land use and elevation were used to compute the fraction of the population within 1 hour walking distance of the nearest public health facility offering curative services. This metric was summarised for each of the 78 counties in South Sudan and compared with simpler metrics of the proportion of the population within 5 km of a health facility. In 2016, it is estimated that there were 1747 public health facilities, out of which 294 were non-functional in part due to the on-going civil conflict. Access to a service provider was poor with only 25.7% of the population living within one-hour walking time to a facility and 28.6% of the population within 5 km. These metrics, when applied sub-nationally, identified the same high priority, most vulnerable counties. Simple metrics based upon population distribution and location of facilities might be as valuable as more complex models of health access, where attribute data on travel routes are imperfect or incomplete and sparse. Disparities exist in South Sudan among counties and those with the poorest health access should be targeted for priority expansion of clinical services.

Assessing needs and assets for building a regional network infrastructure to reduce cancer related health disparities.

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Wells, Kristen J; Lima, Diana S; Meade, Cathy D; Muñoz-Antonia, Teresita; Scarinci, Isabel; McGuire, Allison; Gwede, Clement K; Pledger, W Jack; Partridge, Edward; Lipscomb, Joseph; Matthews, Roland; Matta, Jaime; Flores, Idhaliz; Weiner, Roy; Turner, Timothy; Miele, Lucio; Wiese, Thomas E; Fouad, Mona; Moreno, Carlos S; Lacey, Michelle; Christie, Debra W; Price-Haywood, Eboni G; Quinn, Gwendolyn P; Coppola, Domenico; Sodeke, Stephen O; Green, B Lee; Lichtveld, Maureen Y

2014-06-01

Significant cancer health disparities exist in the United States and Puerto Rico. While numerous initiatives have been implemented to reduce cancer disparities, regional coordination of these efforts between institutions is often limited. To address cancer health disparities nation-wide, a series of regional transdisciplinary networks through the Geographic Management Program (GMaP) and the Minority Biospecimen/Biobanking Geographic Management Program (BMaP) were established in six regions across the country. This paper describes the development of the Region 3 GMaP/BMaP network composed of over 100 investigators from nine institutions in five Southeastern states and Puerto Rico to develop a state-of-the-art network for cancer health disparities research and training. We describe a series of partnership activities that led to the formation of the infrastructure for this network, recount the participatory processes utilized to develop and implement a needs and assets assessment and implementation plan, and describe our approach to data collection. Completion, by all nine institutions, of the needs and assets assessment resulted in several beneficial outcomes for Region 3 GMaP/BMaP. This network entails ongoing commitment from the institutions and institutional leaders, continuous participatory and engagement activities, and effective coordination and communication centered on team science goals. Copyright © 2014 Elsevier Ltd. All rights reserved.

Assessing Needs and Assets for Building a Regional Network Infrastructure to Reduce Cancer Related Health Disparities

Science.gov (United States)

Wells, Kristen J.; Lima, Diana S.; Meade, Cathy D.; Muñoz-Antonia, Teresita; Scarinci, Isabel; McGuire, Allison; Gwede, Clement K.; Pledger, W. Jack; Partridge, Edward; Lipscomb, Joseph; Matthews, Roland; Matta, Jaime; Flores, Idhaliz; Weiner, Roy; Turner, Timothy; Miele, Lucio; Wiese, Thomas E.; Fouad, Mona; Moreno, Carlos S.; Lacey, Michelle; Christie, Debra W.; Price-Haywood, Eboni G.; Quinn, Gwendolyn P.; Coppola, Domenico; Sodeke, Stephen O.; Green, B. Lee; Lichtveld, Maureen Y.

2015-01-01

Significant cancer health disparities exist in the United States and Puerto Rico. While numerous initiatives have been implemented to reduce cancer disparities, regional coordination of these efforts between institutions is often limited. To address cancer health disparities nationwide, a series of regional transdisciplinary networks through the Geographic Management Program (GMaP) and the Minority Biospecimen/Biobanking Geographic Management Program (BMaP) were established in six regions across the country. This paper describes the development of the Region 3 GMaP/BMaP network composed of over 100 investigators from nine institutions in five Southeastern states and Puerto Rico to develop a state-of-the-art network for cancer health disparities research and training. We describe a series of partnership activities that led to the formation of the infrastructure for this network, recount the participatory processes utilized to develop and implement a needs and assets assessment and implementation plan, and describe our approach to data collection. Completion, by all nine institutions, of the needs and assets assessment resulted in several beneficial outcomes for Region 3 GMaP/BMaP. This network entails ongoing commitment from the institutions and institutional leaders, continuous participatory and engagement activities, and effective coordination and communication centered on team science goals. PMID:24486917

Developing Partnerships to Reduce Disparities in Cancer Screening

OpenAIRE

Breslau, Erica S.; Rochester, Phyllis W.; Saslow, Debbie; Crocoll, Caroline E.; Johnson, Lenora E.; Vinson, Cynthia A.

2010-01-01

Background Interventions in scientific settings to improve the well-being of women who are not regularly screened for cancer have failed. Consequently, community-based prevention and control efforts are needed. Community Context From 2003 through 2007, three federal agencies and 1 nongovernmental agency collaborated with county-level public health counterparts from 6 states to address screening disparities in cervical and breast cancer in counties with the highest prevalence. This case study ...

Public health emergencies and the public health/managed care challenge.

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Rosenbaum, Sara; Skivington, Skip; Praeger, Sandra

2002-01-01

The relationship between insurance and public health is an enduring topic in public health policy and practice. Insurers share certain attributes with public health. But public health agencies operate in relation to the entire community that they are empowered by public law to serve and without regard to the insurance status of community residents; on the other hand, insurers (whether managed care or otherwise) are risk-bearing entities whose obligations are contractually defined and limited to enrolled members and sponsors. Public insurers such as Medicare and Medicaid operate under similar constraints. The fundamental characteristics that distinguish managed care-style insurance and public health become particularly evident during periods of public health emergency, when a public health agency's basic obligations to act with speed and flexibility may come face to face with the constraints on available financing that are inherent in the structure of insurance. Because more than 70% of all personal health care in the United States is financed through insurance, public health agencies effectively depend on insurers to finance necessary care and provide essential patient-level data to the public health system. Critical issues of state and federal policy arise in the context of the public health/insurance relations during public health emergencies. These issues focus on coverage and the power to make coverage decisions, as well as the power to define service networks and classify certain data as exempt from public reporting. The extent to which a formal regulatory approach may become necessary is significantly affected by the extent to which private entities themselves respond to the problem with active efforts to redesign their services and operations to include capabilities and accountability in the realm of public health emergency response.

Training public health superheroes: five talents for public health leadership.

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Day, Matthew; Shickle, Darren; Smith, Kevin; Zakariasen, Ken; Moskol, Jacob; Oliver, Thomas

2014-12-01

Public health leaders have been criticized for their policy stances, relationships with governments and failure to train the next generation. New approaches to the identification and training of public health leaders may be required. To inform these, lessons can be drawn from public health 'superheroes'; public health leaders perceived to be the most admired and effective by their peers. Members and Fellows of the UK Faculty of Public Health were contacted via e-newsletter and magazine and asked to nominate their 'Public Health Superhero'. Twenty-six responses were received, nominating 40 different people. Twelve semi-structured interviews were conducted. Thematic analysis, based on 'grounded theory', was conducted. Five leadership 'talents' for public health were identified: mentoring-nurturing, shaping-organizing, networking-connecting, knowing-interpreting and advocating-impacting. Talent-based approaches have been effective for leadership development in other sectors. These talents are the first specific to the practice of public health and align with some aspects of existing frameworks. An increased focus on identifying and developing talents during public health training, as opposed to 'competency'-based approaches, may be effective in strengthening public health leadership. Further research to understand the combination and intensity of talents across a larger sample of public health leaders is required. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

[Public health services between "new public health" and "new public management"].

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Oppen, M

1996-04-01

Today, a substantial reorientation of the Public Health services in the Federal Republic of Germany is broadly seen necessary. Patterns of functional and organisational restructuring of Public Health services on the regional and the communal level are closely linked with concepts of prevention and health promotion. Hence, a number of agencies have already adopted new tasks and functions like comprehensive and transorganizational planning, coordination and evaluation as well as the establishment of new reporting systems. Presently, the transformation process from the bureaucratic mode of administering matters of health to a new Public Health orientation receives new impacts from the international "New Public Management" movement. Comparatively late, with the beginning of the 1990s, a growing number of German municipalities has introduced new concepts of administration. Local government administrations, of which the Public Health services are a part, follow the model of modern service organizations producing services in a more efficient, professionalized and consumer-oriented way. Specific elements of economising modernisation programmes like re-distribution of tasks, de-centralisation, extension of managerial capacities, setting of stimulating working conditions that provide employees with greater independence of action as well as career opportunities, are at the same time prerequisites for innovative strategies of health protection and coordination policies of Public Health services.

Lifecourse Approach to Racial/Ethnic Disparities in Childhood Obesity123

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Dixon, Brittany; Peña, Michelle-Marie; Taveras, Elsie M.

2012-01-01

Eliminating racial/ethnic disparities in health and health care is a national priority, and obesity is a prime target. During the last 30 y in the United States, the prevalence of obesity among children has dramatically increased, sparing no age group. Obesity in childhood is associated with adverse cardio-metabolic outcomes such as hypertension, hyperlipidemia, and type II diabetes and with other long-term adverse outcomes, including both physical and psychosocial consequences. By the preschool years, racial/ethnic disparities in obesity prevalence are already present, suggesting that disparities in childhood obesity prevalence have their origins in the earliest stages of life. Several risk factors during pregnancy are associated with increased risk of offspring obesity, including excessive maternal gestational weight gain, gestational diabetes, smoking during pregnancy, antenatal depression, and biological stress. During infancy and early childhood, rapid infant weight gain, infant feeding practices, sleep duration, child’s diet, physical activity, and sedentary practices are associated with the development of obesity. Studies have found substantial racial/ethnic differences in many of these early life risk factors for childhood obesity. It is possible that racial/ethnic differences in early life risk factors for obesity might contribute to the high prevalence of obesity among minority preschool-age children and beyond. Understanding these differences may help inform the design of clinical and public health interventions and policies to reduce the prevalence of childhood obesity and eliminate disparities among racial/ethnic minority children. PMID:22332105

Social determinants of self-reported health for Canada's indigenous peoples: a public health approach.

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Bethune, R; Absher, N; Obiagwu, M; Qarmout, T; Steeves, M; Yaghoubi, M; Tikoo, R; Szafron, M; Dell, C; Farag, M

2018-04-14

In Canada, indigenous peoples suffer from a multitude of health disparities. To better understand these disparities, this study aims to examine the social determinants of self-reported health for indigenous peoples in Canada. This study uses data from Statistics Canada's Aboriginal Peoples Survey 2012. Multinomial logistic regression models were used to examine how selected social determinants of health are associated with self-reported health among off-reserve First Nations and Métis peoples in Canada. Our analysis shows that being older, female, and living in urban settings were significantly associated with negative ratings of self-reported health status among the indigenous respondents. Additionally, we found that higher income and levels of education were strongly and significantly associated with positive ratings of self-reported health status. Compared with indigenous peoples with an education level of grade 8 or lower, respondents with higher education were 10 times (5.35-22.48) more likely to report 'excellent' and 'very good' health. Respondents who earned more than $40,000 annually were three times (2.17-4.72) more likely to report 'excellent' and 'very good' health compared with those who earned less than $20,000 annually. When interacted with income, we also found that volunteering in the community is associated with better self-reported health. There are known protective determinants (income and education) and risk determinants (location of residence, gender, and age) which are associated with self-reported health status among off-reserve First Nations and Métis peoples. For indigenous-specific determinants, volunteering in the community appears to be associated with self-perceived health status. Thus, addressing these determinants will be necessary to achieve better health outcomes for indigenous peoples in Canada. Next steps include developing indigenous-specific social determinants of health indicators that adequately measure culture, connection

Health Disparities and Relational Well-Being between Multi- and Mono-Ethnic Asian Americans

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Zhang, Wei

2013-01-01

Focusing on Hawaii, a state with 21.3% of the population being multi-racial according to the 2010 U.S. Census, this study aims to examine the existence and nature of health disparities between mono- and multi-ethnic Asian Americans and the importance of Relational Well-Being in affecting the health of Asian Americans. A series of ordinary least…

Leprosy: International Public Health Policies and Public Health Eras

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Niyi Awofeso

2011-09-01

Full Text Available Public health policies continue to play important roles in national and international health reforms. However, the influence and legacies of the public health eras during which such policies are formulated remain largely underappreciated. The limited appreciation of this relationship may hinder consistent adoption of public health policies by nation-states, and encumber disinvestment from ineffective or anachronistic policies. This article reviews seven public health eras and highlights how each era has influenced international policy formulation for leprosy control—“the fertile soil for policy learning”. The author reiterates the role of health leadership and health activism in facilitating consistency in international health policy formulation and implementation for leprosy control.

Monographs - SEER Publications

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In-depth publications on topics in cancer statistics, including collaborative staging and registry data, cancer survival from a policy and clinical perspective, a description of cancer in American Indians/Alaska Natives, and measures of health disparities.

The health and health system of South Africa: historical roots of current public health challenges.

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Coovadia, Hoosen; Jewkes, Rachel; Barron, Peter; Sanders, David; McIntyre, Diane

2009-09-05

The roots of a dysfunctional health system and the collision of the epidemics of communicable and non-communicable diseases in South Africa can be found in policies from periods of the country's history, from colonial subjugation, apartheid dispossession, to the post-apartheid period. Racial and gender discrimination, the migrant labour system, the destruction of family life, vast income inequalities, and extreme violence have all formed part of South Africa's troubled past, and all have inexorably affected health and health services. In 1994, when apartheid ended, the health system faced massive challenges, many of which still persist. Macroeconomic policies, fostering growth rather than redistribution, contributed to the persistence of economic disparities between races despite a large expansion in social grants. The public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies. Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector. The HIV epidemic has contributed to and accelerated these challenges. All of these factors need to be addressed by the new government if health is to be improved and the Millennium Development Goals achieved in South Africa.

Using an External Exposome Framework to Examine Pregnancy-Related Morbidities and Mortalities: Implications for Health Disparities Research

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Tonny J. Oyana

2015-12-01

Full Text Available Objective: We have conducted a study to assess the role of environment on the burden of maternal morbidities and mortalities among women using an external exposome approach for the purpose of developing targeted public health interventions to decrease disparities. Methods: We identified counties in the 48 contiguous USA where observed low birthweight (LBW rates were higher than expected during a five-year study period. The identification was conducted using a retrospective space-time analysis scan for statistically significant clusters with high or low rates by a Discrete Poisson Model. Results: We observed statistically significant associations of LBW rate with a set of predictive variables. However, in one of the two spatiotemporal models we discovered LBW to be associated with five predictive variables (teen birth rate, adult obesity, uninsured adults, physically unhealthy days, and percent of adults who smoke in two counties situated in Alabama after adjusting for location changes. Counties with higher than expected LBW rates were similarly associated with two environmental variables (ozone and fine particulate matter. Conclusions: The county-level predictive measures of LBW offer new insights into spatiotemporal patterns relative to key contributory factors. An external framework provides a promising place-based approach for identifying “hotspots” with implications for designing targeted interventions and control measures to reduce and eliminate health disparities.

Persistent disparities in obesity risk among public schoolchildren from childhood through adolescence.

Science.gov (United States)

Chen, Danhong; Thomsen, Michael R; Nayga, Rodolfo M; Bennett, Judy L

2016-08-01

Arkansas is among the poorest states and has high rates of childhood obesity. In 2003, it became the first state to systematically screen public schoolchildren for unhealthy weight status. This study aims to examine the socioeconomic disparities in Body Mass Index (BMI) growth and the risk of the onset of obesity from childhood through adolescence. This study analyzed (in 2015) the data for a large cohort of Arkansas public schoolchildren for whom BMIs were measured from school years 2003/2004 through 2009/2010. A linear growth curve model was used to assess how child-level sociodemographics and neighborhood characteristics were associated with growth in BMI z-scores. Cox regression was subsequently used to investigate how these factors were associated with the onset of obesity. Because children might be classified as obese in multiple years, sensitivity analysis was conducted using recurrent event Cox regression. Survival analysis indicated that the risk of onset of obesity rose sharply between ages of 5 and 10 and then again after age 15. The socioeconomic disparities in obesity risk persisted from kindergarten through adolescence. While better access to full service restaurants was associated with lower risk of the onset of obesity (Hazard Ratio (HR)=0.98, 95% CI=0.97-0.99), proximity to fast food restaurants was related to increased risk of the onset of obesity (HR=1.01, 95% CI=1.00-1.01). This analysis stresses the need for policies to narrow the socioeconomic gradient and identifies important time periods for preventative interventions in childhood obesity. Copyright © 2016 Elsevier Inc. All rights reserved.

Evidence for Policy Making: Health Services Access and Regional Disparities in Kerman

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Mina Anjomshoa

2013-12-01

Full Text Available Background and purpose: Health indices, regarding to their role in the development of society, are one of the most important indices at national level. Success of national development programs is largely dependent on the establishment of appropriate goals at the health sector, among which access to healthcare facilities is an essential requirement. The aim of this study was to examine the disparities in health services access across the Kerman province. Materials and Methods: This was a cross-sectional study. Study sample included the cities of Kerman province, ranked based on 15 health indices. Data was collected from statistical yearbook. The indices were weighted using Shannon entropy, then using the TOPSIS technique and the result were classified into three categories in terms of the level of development across towns. Results: The findings showed distinct regional disparities in health services across Kerman province and the significant difference was observed between the cities in terms of development. Shannon entropy introduced the number of pharmacologist per 10 thousand people as the most important indicator and the number of rural active health center per 1000 people as the less important indicator. According to TOPSIS, Kerman town (0.719 and Fahraj (0.1151 ranked the first and last in terms of access to health services respectively. Conclusion: There are significant differences between cities of Kerman province in terms of access to health care facilities and services. Therefore, it is recommended that officials and policy-makers determine resource allocation priorities according to the degree of development for a balanced and equitable distribution of health care facilities.

Cancer, culture, and health disparities: time to chart a new course?

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Kagawa-Singer, Marjorie; Dadia, Annalyn Valdez; Yu, Mimi C; Surbone, Antonella

2010-01-01

Little progress has been made over the last 40 years to eliminate the racial/ethnic differences in incidence, morbidity, avoidable suffering, and mortality from cancer that result from factors beyond genetic differences. More effective strategies to promote equity in access and quality care are urgently needed because the changing demographics of the United States portend that this disparity will not only persist but significantly increase. Such suffering is avoidable. The authors posit that culture is a prime factor in the persistence of health disparities. However, this concept of culture is still poorly understood, inconsistently defined, and ineffectively used in practice and research. The role of culture in the causal pathway of disparities and the potential impact of culturally competent cancer care on improving cancer outcomes in ethnic minorities has, thus, been underestimated. In this article, the authors provide a comprehensive definition of culture and demonstrate how it can be used at each stage of the cancer care continuum to help reduce the unequal burden of cancer. The authors conclude with suggestions for clinical practice to eliminate the disconnection between evidence-based, quality, cancer care and its delivery to diverse population groups.

Understanding deficiencies of leadership in advancing health equity: a case of pit bulls, public health, and pimps.

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Clancy, Gerard P

2015-04-01

Market- and legislation-driven health reforms are being implemented across the United States. Within this time of great change for health care delivery systems and medical schools lie opportunities to address the country's long-standing health inequities by using community needs assessments, health information technologies, and new models for care and payment. In this Commentary, the author, a university regional campus leader, shares several difficult personal experiences to demonstrate that health equity work undertaken by academic institutions also requires institutional leaders to pay attention to and gain an understanding of issues that go beyond public health data. The author reflects on lessons learned and offers recommendations that may help academic health center and university leaders be more effective as they take on the complex tasks involved in improving health inequities. These include reflection on personal strengths and deficiencies, engagement with the community, recognition of the historical roots of health disparities, and the development of trusting relationships between the institution and the community.

Examining health literacy disparities in the United States: a third look at the National Assessment of Adult Literacy (NAAL

Directory of Open Access Journals (Sweden)

R. V. Rikard

2016-09-01

Full Text Available Abstract Background In the United States, disparities in health literacy parallel disparities in health outcomes. Our research contributes to how diverse indicators of social inequalities (i.e., objective social class, relational social class, and social resources contribute to understanding disparities in health literacy. Methods We analyze data on respondents 18 years of age and older (N = 14,592 from the 2003 National Assessment of Adult Literacy (NAAL restricted access data set. A series of weighted Ordinary Least Squares (OLS regression models estimate the association between respondent’s demographic characteristics, socioeconomic status (SES, relational social class, social resources and an Item Response Theory (IRT based health literacy measure. Results Our findings are consistent with previous research on the social and SES determinants of health literacy. However, our findings reveal the importance of relational social status for understanding health literacy disparities in the United States. Objective indicators of social status are persistent and robust indicators of health literacy. Measures of relational social status such as civic engagement (i.e., voting, volunteering, and library use are associated with higher health literacy levels net of objective resources. Social resources including speaking English and marital status are associated with higher health literacy levels. Conclusions Relational indicators of social class are related to health literacy independent of objective social class indicators. Civic literacy (e.g., voting and volunteering are predictors of health literacy and offer opportunities for health intervention. Our findings support the notion that health literacy is a social construct and suggest the need to develop a theoretically driven conceptual definition of health literacy that includes a civic literacy component.

Disparities in Arctic Health

Centers for Disease Control (CDC) Podcasts

Life at the top of the globe is drastically different. Harsh climate devoid of sunlight part of the year, pockets of extreme poverty, and lack of physical infrastructure interfere with healthcare and public health services. Learn about the challenges of people in the Arctic and how research and the International Polar Year address them.

Accelerators: Sparking Innovation and Transdisciplinary Team Science in Disparities Research

Science.gov (United States)

Horowitz, Carol R.; Shameer, Khader; Gabrilove, Janice; Atreja, Ashish; Shepard, Peggy; Goytia, Crispin N.; Smith, Geoffrey W.; Dudley, Joel; Manning, Rachel; Bickell, Nina A.; Galvez, Maida P.

2017-01-01

Development and implementation of effective, sustainable, and scalable interventions that advance equity could be propelled by innovative and inclusive partnerships. Readied catalytic frameworks that foster communication, collaboration, a shared vision, and transformative translational research across scientific and non-scientific divides are needed to foster rapid generation of novel solutions to address and ultimately eliminate disparities. To achieve this, we transformed and expanded a community-academic board into a translational science board with members from public, academic and private sectors. Rooted in team science, diverse board experts formed topic-specific “accelerators”, tasked with collaborating to rapidly generate new ideas, questions, approaches, and projects comprising patients, advocates, clinicians, researchers, funders, public health and industry leaders. We began with four accelerators—digital health, big data, genomics and environmental health—and were rapidly able to respond to funding opportunities, transform new ideas into clinical and community programs, generate new, accessible, actionable data, and more efficiently and effectively conduct research. This innovative model has the power to maximize research quality and efficiency, improve patient care and engagement, optimize data democratization and dissemination among target populations, contribute to policy, and lead to systems changes needed to address the root causes of disparities. PMID:28241508

Health disparities, social injustice, and the culture of nursing.

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Giddings, Lynne S

2005-01-01

Nurses are well positioned to challenge institutionalized social injustices that lead to health disparities. The aim of this cross-cultural study was to collect stories of difference and fairness within nursing. The study used a life history methodology informed by feminist theory and critical social theory. Life story interviews were conducted with 26 women nurses of varying racial, cultural, sexual identity, and specialty backgrounds in the United States (n = 13) and Aotearoa New Zealand (n = 13). Participants reported having some understanding of social justice issues. They were asked to reflect on their experience of difference and fairness in their lives and specifically within nursing. Their stories were analyzed using a life history immersion method. Nursing remains attached to the ideological construction of the "White good nurse." Taken-for-granted ideals privilege those who fit in and marginalize those who do not. The nurses experienced discrimination and unfairness, survived by living in two worlds, learned to live in contradiction, and worked surreptitiously for social justice. For nurses to contribute to changing the systems and structures that maintain health disparities, the privilege of not seeing difference and the processes of mainstream violence that support the construction of the "White good nurse" must be challenged. Nurses need skills to deconstruct the marginalizing social processes that sustain inequalities in nursing and healthcare. These hidden realities--racism, sexism, heterosexism, and other forms of discrimination--will then be made visible and open to challenge.

Partners in Public Health: Public Health Collaborations With Schools of Pharmacy, 2015.

Science.gov (United States)

DiPietro Mager, Natalie A; Ochs, Leslie; Ranelli, Paul L; Kahaleh, Abby A; Lahoz, Monina R; Patel, Radha V; Garza, Oscar W; Isaacs, Diana; Clark, Suzanne

To collect data on public health collaborations with schools of pharmacy, we sent a short electronic survey to accredited and preaccredited pharmacy programs in 2015. We categorized public health collaborations as working or partnering with local and/or state public health departments, local and/or state public health organizations, academic schools or programs of public health, and other public health collaborations. Of 134 schools, 65 responded (49% response rate). Forty-six (71%) responding institutions indicated collaborations with local and/or state public health departments, 34 (52%) with schools or programs of public health, and 24 (37%) with local and/or state public health organizations. Common themes of collaborations included educational programs, community outreach, research, and teaching in areas such as tobacco control, emergency preparedness, chronic disease, drug abuse, immunizations, and medication therapy management. Interdisciplinary public health collaborations with schools of pharmacy provide additional resources for ensuring the health of communities and expose student pharmacists to opportunities to use their training and abilities to affect public health. Examples of these partnerships may stimulate additional ideas for possible collaborations between public health organizations and schools of pharmacy.

Measuring Racial and Ethnic Disparities in Health Care: Efforts to Improve Data Collection.

OpenAIRE

Patricia Collins Higgins; Erin Fries Taylor

2009-01-01

Disparities in the quality of health care contribute to higher rates of disease, disability, and mortality in racial and ethnic minority groups. A new policy brief examines recent federal and state activities aimed at strengthening the collection of health-related data on race, ethnicity, and primary language. It highlights three states—California, Massachusetts, and New Jersey—that implemented laws or regulations guiding data collection activities by hospitals, health plans, and governme...

Increasing Community Research Capacity to Address Health Disparities.

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Komaie, Goldie; Ekenga, Christine C; Sanders Thompson, Vetta L; Goodman, Melody S

2017-02-01

The Community Research Fellows Training program is designed to enhance capacity for community-based participatory research; program participants completed a 15-week, Master of Public Health curriculum. We conducted qualitative, semistructured interviews with 81 participants from two cohorts to evaluate the learning environment and how the program improved participants' knowledge of public health research. Key areas that provided a conducive learning environment included the once-a-week schedule, faculty and participant diversity, and community-focused homework assignments. Participants discussed how the program enhanced their understanding of the research process and raised awareness of public health-related issues for application in their personal lives, professional occupations, and in their communities. These findings highlight key programmatic elements of a successful public health training program for community residents.

We are Not Hard-to-Reach: Community Competent Research to Address Racial Tobacco-Related Disparities

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Dr. Webb Hooper is Associate Director for Cancer Disparities Research and Director of the Office of Cancer Disparities Research in the Case Comprehensive Cancer Center at Case Western Reserve University. She is also Professor of Oncology, Family Medicine & Community Health and Psychological Sciences. Dr. Webb Hooper is a licensed clinical health psychologist whose research interests are in chronic illness prevention and cancer risk behaviors, with an emphasis on minority health and racial/ethnic disparities. Much of her research focuses on tobacco use and weight management interventions, the development of culturally specific approaches, and understanding relationships between behavior change and race/ethnicity, cultural variables, modifiable risk factors, and the biological stress response. Dr. Webb Hooper has received international recognition for her contributions to nicotine and tobacco research, and is a leader in the field of cancer health disparities. Her research goal is to make a significant public health impact by reducing the prevalence of cancer and cancer health disparities in high-risk populations. Her long-term goal is to help eliminate disparities in chronic diseases. Dr. Webb Hooper’s research has been funded with over $9 million dollars by the National Cancer Institute (NCI), American Cancer Society (ACS), CVS Health Foundation, and the Florida Department of Health James and Esther King Biomedical Research Program.  In addition, Dr. Webb Hooper serves on committees for the NIH, several peer-reviewed journal editorial boards, is an Associate Editor of the Ethnicity & Disease Journal, and is Co-Chair of the Health Disparities Network of the Society for Research on Nicotine and Tobacco. WebEx When it's time, join the meeting. Meeting number (access code):  857 862 211 Meeting password:  Colloqu1@ Join by phone 1-650-479-3207 Call-in toll number (US/Canada) Can't join the meeting? IMPORTANT NOTICE:  Please note that this WebEx service allows

Counties eliminating racial disparities in colorectal cancer mortality.