Term
| Health disparities definition |
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Definition
| Disproportions in burden of illness, injury, disability, or mortality by one group of individuals in relation to another group |
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Term
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Definition
| Disproportions in health insurance coverage, access to care, and quality of care by one group of individuals in relation to another group |
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Term
| Disparities are the framework for |
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Definition
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Definition
| a difference in health outcome |
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Term
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Definition
| factors that influence health |
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Term
| Health Disparities: Causes |
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Definition
- Individual
• Maintaining healthy weight, medication adherence, follow up when recommended
- Provider
• Bias, barriers in communication (cultural, linguistic), time
- System
• Organization structure, finances (reimbursement rates)
•-Social and Environmental
• Poverty, education, proximity to care, walkability of neighborhood |
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Term
| Healthy People 2020 seeks to assess |
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Definition
health disparities by tracking rates of illness, death, chronic disease, and behaviors as related to various demographic subgroups:
• Race and ethnicity
• Gender
• Sexual identity and orientation
• Disability status or special health care needs • Geographic location (rural and urban) |
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Term
Health Disparities: Causes
• Influences on health: |
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Definition
• High-quality education
• Nutritious food
• Decent and safe housing
• Affordable, reliable public transportation • Culturally sensitive health care providers • Health insurance
• Clean water and nonpolluted air |
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Term
Health Disparities: Causes
• CDC has created five key determinants of population health: |
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Definition
1. Genes and biology
2. Health behaviors
3. Medical care
4. Social/societal characteristics
5. Total ecology |
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Term
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Definition
three key areas of focus...loosely
translated to “overhaul everything:"
1. Improve conditions of daily life
2. Tackle the inequitable distribution of power, money, and resources
3. Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health |
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Term
| Health Disparities: Why It Matters |
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Definition
So when we look at the distribution of why this is actually important, we look at our distribution of US populations here by race and ethnicity and where we're at in 2015, and if we continue on the trend that we're on right now where we're projected to be in 2045.
So we can see here is that we're becoming a more diverse population. And with more diversity means different cultural backgrounds, cultural influences, ways of life. That normal picture of what daily life looks like is going to be varied for all of our patients depending on their background.
And there's also clear-cut disparities that we know about already that have been identified on things like risk of cancer-- not only just risk of getting different types of cancers, but risk of death for cancer. So morbidity and mortality differ by race within the same diagnosis. And so these are things that we need to keep in mind so that we can coordinate care for these patients who fall into these things. |
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Term
| health disparities income gap |
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Definition
So you look at the richest 20% versus the poorest 20% and there's over $180,000 annual household income difference between those two populations there. So in reality, this gap is so big that when we deliver health care to our patients-- especially if you're seeing patients who span this gap-- the patient education, and the resources, and the recommendations that you make to one patient really does not translate to all patients.
And that's where it's looking at the patient that's sitting in front of you and providing care that is specific to that individual, understanding the risks that are in play for individuals who fall into this poor 20%, and making sure that we're providing them with the resources, providing the appropriate screenings, and connecting them early on-- trying to intervene early on-- so that we can improve their health outcome and try to reduce those health disparities across races |
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Term
| under age 65 who did not receive or delayed care in past 12 months |
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Definition
So this one I thought was interesting here percent of non-elderly individuals-- so under the age of 65-- who did not receive or delayed care in the past 12 months by race or ethnicity. And so when we look at this here, on the left side here it's they did not see-- or I'm sorry, on the right side, it's they did not see a doctor for needed care because of cost. So these individuals, because of cost they delayed their care. And then the other people are delayed for other reasons here, the other column here.
So when we look at this, we're still hovering around 20% of individuals as a whole are not receiving care or are delaying care because of cost. And we know what happens if you don't go to primary care because it's too expensive, and you delay, and then your symptoms progress-- you typically wind up in the ER. And that bill for you as an individual is significantly higher. Also the strain on the health care system is significantly higher.
So what we can be doing in our clinic-- we need to focus on changes that can be made to make health care more affordable for our patients to be able to come to primary care and intervening earlier. I know even with high deductible plans-- so you look at people who have great health benefits and insurance but they have a high deductible plan, so maybe they have to pay $4,000 or $5,000, $6,000 completely out of pocket before their insurance kicks in, they're not going to want to go to their primary care doctor where it's going to be $150, $200 to be seen to get a routine screening a lot of times. And that can be really challenging to overcome that.
So it's not just uninsured individuals that are facing this. There are many individuals who are facing this cost barrier. And it's extremely prohibitive when it comes to receiving the services that we need. So talking to our patients with that, talking to them about some of the screening tests that are upcoming, and then also trying to consolidate things into visits for our patients.
So we don't want to overload ourselves. But if we know that there is a health disparity that exists for a certain ethnic background, or a certain population that we're dealing with, or a certain individual then seeing what screenings are going to be upcoming-- can we combine all of those, can we prepare ourselves on our back end? When this patient comes in, can we kind of knock out multiple things in one appointment for them to help reduce the costs there? |
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Term
| selected health conditions in nonelderly |
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Definition
This was here. So non-elderly adults with selected conditions by race, ethnicity. So we're looking at currently having asthma, told by a doctor that they have diabetes, or are told that they have had a heart attack or heart disease. And you can see the differences by race here as well.
So this is, again, knowing who we're screening primarily and making sure that we're applying the appropriate screening techniques, and conversations, and patient education to populations who fall into these groups where the disparity, you know, falls out of their favor, where they're at a higher risk. |
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Term
| HIV diagnosis and dealth rate |
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Definition
This one, age-adjusted HIV and AIDS diagnosis and death rate. So this is where I was saying even among the same diagnosis you can have different outcomes as far as morbidity and mortality goes, so which means that some people who get diagnosed with HIV and AIDS are getting the care that they need; other people are not.
And this is linked to race. And we can see very clear discrepancies here based on these people. So it's very important to do outreach in these communities, identification in these communities, and make sure that treatment methods are known. |
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Term
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Definition
| minority culture becomes fully enveloped by the majority culture but both remain changed |
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Term
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Definition
| minority culture becomes more like the majority culture, but maintains unique markers |
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Term
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Definition
| ability to deliver health care services that meet the unique needs of different individuals |
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Term
| satisfaction with healthcare |
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Definition
So, additionally, we know that minority patients tend to be less satisfied with the health care they receive. This is an interesting graphic here because this shows individuals who believe that they would have received better care if they were of a different race. And there's a lot of research that goes around this.
And this is not saying they did receive better or worse care because of their race. This is the patient perception. So whether or not you're approaching the patient the same or not the same, that's not in play here. What this is really looking at is how does a patient feel when they walk out of the room. Do they feel like they would have gotten better care?
And this is where the unconscious bias training really comes into play, looking at our perceptions and the way that we approach these patient encounters. Because we need to make sure that even though patient-- we know that patients are going to feel this way. So what can we be doing to mitigate this? How can we address this up-front in making sure that we're providing culturally-competent care from the very start? |
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Term
Health Disparities: Cultural Competence
• What can we do? |
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Definition
• Provide interpreters
• Recruit minority staff
• Employee training
• Coordinate with community health
• Provide appropriate patient education materials
It is better to ask than assume you know the answers |
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Term
| Health Disparities: Key Initiatives |
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Definition
• Minority Health and Health Disparities Research and Education Act of 2000
- Through Agency for Healthcare Research and Quality (AHRQ) to regularly measure progress of disparity reduction
• Health and Human Services (HHS) Disparities Action Plan (2011)
• Affordable Care Act: creation of the Offices of Minority Health within HHS
• CDC Racial and Ethnic Approaches to Community Health (REACH) grants
- For states, local health departments, universities, and nonprofits to promote community interventions |
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