Health EquityEPID 691 Spring 2012

In a perfect world…

Health Equity Attainment of the highest level of health

for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.

▪ U.S. DHHS, Office of Minority Health, 2010 (quoted in Healthy People 2020)

Understanding Health Equity

Health Disparities

Health Inequity

Social Determinants

Research to Eliminate Inequities

Health Disparities

Differences in the incidence and prevalence of health conditions and health status between groups ▪ Braveman P, 2006

Arise from socioeconomic status, race/ethnicity, sexual orientation, gender, disability status, geographic location, or some combination of these▪ Brennan Ramirez LK, et al., 2008

Health Inequity

Health disparities are referred to as health inequities when they are the result of the systematic and unjust distribution of social determinants (healthy food, good housing, good education, safe neighborhoods, freedom from racism and other forms of discrimination)▪ Brennan Ramirez LK, et al., 2008

Social Determinants

Life-enhancing resources whose distribution across populations effectively determines length and quality of life Food supply Housing Economic and social relationships Transportation Education Health care▪ James S, 2002

Social Determinants

Social determinants of health include, but are not limited to: Socioeconomic status Discrimination Housing Physical environment Food security Child development Culture Social support Healthcare services Transportation Working conditions Democratic participation▪ VDH, 2012

Factors Impacting Social Determinants – Poverty

Note: The number of people in poverty was estimated using direct and regression model estimates based on the Annual Social and Economic Supplement of the Current Population Survey and administrative records and census data, including tax returns and food stamp records.

Source: U.S. Census Bureau, 2004 Small Area Income and Poverty Estimates Program

Race/Ethnicity: AI/AN

Source: U.S. Census Bureau, Census 2000

Race/Ethnicity: Asian/PI

Source: U.S. Census Bureau, Census 2000

Race/Ethnicity: Black

Source: U.S. Census Bureau, Census 2000

Race/Ethnicity: Hispanic/Latino

Source: U.S. Census Bureau, Census 2000

Race/Ethnicity: White

Source: U.S. Census Bureau, Census 2000

Health Disparities by Racial/Ethnic Group or by SES

Cancer Deaths 2004: overall cancer death rate was 1.2 times higher among African Americans than among Whites

Diabetes

2005: Native Hawaiians/PI (15.4%), AI/AN (13.6%), AA (11.3%), Hispanics/Latinos (9.8%) were all significantly more likely to have been diagnosed with diabetes compared to their White counterparts (7%)

HIV/AIDSAfrican Americans, who comprise approximately 12% of the US population, accounted for half of the HIV/AIDS cases diagnosed between 2001 and 2004

Tooth Decay

2001-2004: more than twice as many children from poor families experienced a greater number of untreated cavities than children from non-poor families

Of those children living below 100% of poverty level, Mexican American children (35%) and AA children (26%) were more likely to experience untreated cavities than White children (20%)Table adapted from Brennan Ramirez LK, et

al., 2008

Health Disparities by Racial/Ethnic Group or by SES

Insurance Coverage

2007: Hispanics were 3 times more likely to be uninsured than non-Hispanic Whites (31% versus 10%, respectively)

2007: Families with income below the poverty level were 3 times more likely to be uninsured compared to people with family income more than twice the poverty level

Access to Resources

Lower income and minority communities are less likely to have access to grocery stores with a wide variety of fruits and vegetables

Transportation

38.9% of Hispanic/Latinos, 55.2% of AAs, and 29.6% of Asians live in households with one vehicle or less compared to 24.5% of Whites

Low-income minorities spend more time traveling to work and other daily destinations than do low-income Whites because they have fewer private vehicles and use public transit and car pools more frequentlyTable adapted from Brennan Ramirez LK, et

al., 2008

Factors Impacting Social Determinants – Education

Source: 2005 CDC Area Resource File

Note: "High school degree" includes either a high school diploma or the equivalent (G.E.D.)

Health Disparities by Education

Access to Care

2006: Adults with less than a high school degree were 50% less likely to have visited a doctor in the past 12 months compared to those with at least a bachelor’s degree

Infant Mortality2004: infant mortality is 1.5 times higher when the mother has less than 12 yrs. education compared with >13 yrs. education

EmploymentAdults with less than a high school education were 3 times more likely to be unemployed than those with a bachelor’s degree

Education

According to the National Assessment of Adult Literacy, AA, Hispanic/Latino, and AI/AN adults were significantly more likely to have below basic health literacy compared to their White and Asian/PI counterpartsHispanic/Latino adults had the lowest average health literacy score compared to adults in other racial/ethnic groups2005: Hispanics/Latinos and AAs were significantly more likely to have dropped out of high school (22% and 10%, respectively) compared to Whites (6%)

Table adapted from Brennan Ramirez LK, et al., 2008

Factors Impacting Social Determinants – Urban vs. Rural

Source: 2006 NCHS Urban-Rural Classification Scheme for Counties

Based on the Office of Management and Budget's 2000 standards for defining metropolitan and micropolitan statistical areas, the December 2005 delineation of these areas, and Vintage 2004 postcensal estimates of the resident U.S. population.

Health Disparities by Urban/Rural Areas

Transportation Rural residents must travel greater distances than urban residents to reach health care delivery sites

Insurance Coverage

Residents of nonmetropolitan areas are more likely to be uninsured or covered by Medicaid and less likely to have private insurance coverage than residents of metropolitan areas

Table adapted from Brennan Ramirez LK, et al., 2008

Current Research: Programs in U.S. Health Equity

Health Equity Institute (San Francisco State University) BANPH: Bay Area Network for Positive

Health iN Touch: ODLs via Mobile Platforms for

Youth with Obesity and Depression MASAI: Reframing the Down Low: The

Context of HIV Risk among African American Men

Current Research: Programs in U.S. Health Equity

Robert Wood Johnson Foundation Finding Answers/Aligning Forces for

Quality Dartmouth Atlas Project Transforming Clinical Practice to

Eliminate Racial-Ethnic Disparities in Healthcare

Research and Action Priorities for Linking Public Health, Food Systems, and Sustainable Agriculture

Accountability for Racial Equity in Healthcare

Organizations/Programs

Kaiser Family Foundation CDC Office of Minority Health and

Health Equity NPA (National Partnership for Action)

to End Health Disparities DHHS: Health Care for the Homeless

Program

References

U.S. Department of Health and Human Services, Office of Minority Health. National Partnership for Action to End Health Disparities. The National Plan for Action Draft as of February 17, 2010. Chapter 1: Introduction. Available at: http://www.minorityhealth.hhs.gov/npa/templates/browse.aspx?&lvl=2&lvlid=34

Braveman P. Health disparities and health equity: concepts and measurement. Annual Review of Public Health 2006;27:167–194.

Brennan Ramirez LK, Baker EA, Metzler M. Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.

James S. Social determinants of health: implications for intervening on racial and ethnic health disparities. Paper presented at: Minority Health Conference, 2002; University of North Carolina.

Virginia Department of Health, Office of Minority Health and Health Equity. Health Equity Definitions. 12 Jan 2012. Available at: http://www.vdh.state.va.us/healthpolicy/healthequity/definitions.htm

www.solvingdisparities.org