PPPM460LectureNotesWeek8.pdf PPPM 460
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This 6 page Class Notes was uploaded by Kaitlyn Endo on Friday September 25, 2015. The Class Notes belongs to PPPM 460 at University of Oregon taught by Nicole Ngo in Spring 2015. Since its upload, it has received 35 views.
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Date Created: 09/25/15
PPPM 460 Lecture Notes Week 8 What are health and health care disparities 0 Wide spectrum of disparities examples I Income I Culture religion I Age I Language I Gender OR Constitution 1857 0 Sec 2 Each elector who offers to vote upon this Consituttion shall be asked by the judges of election this question do you vote for the constitution Yes orNo 0 And also this question I Do you vote for slavery in Oregon Yes or no I And also this question Do you vote for free Negroes in Oregon Yes or no 0 OR voted against slavery but not free blacks except those who lived in OR since 1857 o Officially repealed by voters Nov 2 1926 IAT Reactions 0 I ve taken the Race IAT on many occasions and the result always leaves me feeling a bit creepyquot Racial Discrimination o Pervasive in other sectors I Mortgage lending Blacks and Hispanics are rejected twice as much white applicants I Housing discrimination In urban areas residential segregation is still a problem I Criminal justice I Employment What are health and health care disparities o The short answer Differences in health and health care between populations including I Burden of illness injury mortality I Insurance coverage I Access to and use of care I Quality of care 0 Reasons for disparities I Even if income and education levels are the same minorities are more likely to receive care at lowest quality facilities I Receive a lower quality and intensity of healthcare I Unnatural causes How Racism Impacts pregnancy outcomes video 0 Unnecessary costs I 30 of direct medical costs for Blacks Hispanics and Asian americans are excess costs due to health inequalities 309 billionyear end up paying more because having gotten proper care in the first place everyday experience as minority this is costly to the economy I impacts on risk pools I the health of the individual is almost inseparable from the health of the larger communityquot The Breast Cancer Gap 0 The difference in mortality rates between black women and whte women with breast cancer has widened since 1975 in part because black women have not benefited as much from screening and treatment 0 the reasons behind the blackwhite cancer divide are complex Economic disparities explain some of it Years of racial discrimination and distrust of the medical establishment dating back to the Tuskegee Ala syphilis experiments on black men in the 1930squot 0 Challenge get women screened and treated but how to reach a population that has felt excluded by the healthcare system for so long Linguistic barriers o 1990 US Census 14 million people have no or limited English language skills I Mostly in urban areas I 45 million Hispanic Americans don t speak English I 5 of American Indians don t speak English very wellquot I gt15 million Asian Americans don t speak English 0 In LA 51 of physicians think their patients don t adhere to medical treatments due to cultural or linguistic barriers Hospital Segregation 0 History of Hospital Segregation I Hill Burton Act 1946 Provided communities federal grants and laons to improve the nation s hospital system Hospitals couldn t discriminate but could have separate facilities I 1964 Civil Rights Act Desegregated public services and institutions I 1965 Medicare provided the federal money to start desegregation of hospitals 0 gt1000 hospitals quietly and uneventfully integrated their medical staff waiting rooms and hospital oors in lt4 months 0 Medicare wouldn t give any of their money to hospitals that segregated o The Federal Gov ts use of Title VI and Medicare to Racially Integrated Hospitals in US 1963 through 1967 I If Medicare and Medicaid had not made another single contribution this result would be sufficient to enshire it as one of the most significant social reforms of the decade if not the century I Minorities in Health Professions workforce note that black population was 10 of the total population 18651910 8 medical schools for African Americans were established 1948 13 of all medical schools were closed to African Americans mid 1950s Black physicians made up only 22 of all physicians Trouble to access specialist training 0 Pohl s Memories of Race amp Medicine in a Mid20th Century Southern Community I Pohl s Greenville MS Background Pre1950s 1 white and 2 black medical facilities 0 1895 King s Daughter Hospital 0 1908 Colored Kings Daughters Hospital 0 Sarah Williams Nursing home 1953 Washington County General Hospital Hill Burton Act 0 closed both black facilities 1966 42 of Mississippi s hospitals compiled with Civil Rights Act What were some of the motivations for building black hospitals 0 Keep black laborers healthy 0 Prevent spread of disease into white community 0 African American large part of the work force and worked for white people and thus there was an economic interest Poh s punch line 0 What did pohl try to explore What did she learn instead 0 African Americans articulated their memories as two separated stories one recalling professional medicine s personal attention the other recalling its racial inequalities In Contrast the oral memories of white caregivers used race to emphasize compassion integrity an the value of their work thus avoiding the history of medicine s discriminatory practicesquot 0 punch line individual interaction rather than instructional development 0 Desire of respondents not to talk about segregation I White physicians spoke extensively of their interaction with black patients and nurses without saying anything about the patients who were either denied treatment or made to wait for white patients to be treated first I Calling it the segregationquot not saying it was the white doctors administration I the white physicians in contrast to Mathew Page equated hospital segregation simply with separation and not with racial inequityquot Group Discussion Grubbs 0 Discuss the following points using examples from Good for Harvesting Bad Wednesday for Plantingquot or Pohl s ll Long waits small spaces and compassionate carequot Statistics versus stories Stats are powerful but stories can give a real life situation it s a bigger picture of what s going on Stats can be used to justify things Importance of identifying race as the reason for Robert s wait Bias amp stereotyping It s quottheyquot who institutionalize it focus on the people not the larger institution Believed that racial bias is a thing of the past but it really is still an issue but history of medicine is built on segregation and racial bias hard to move forward Difference between doctor role and advocate role Lack of empowerment Policy approaches CDC relatively little progress as been made toward the goal of eliminating racial ethnic disparities among a wide range of health indicatorsquot Today Discuss how ACA and other policies address disparities especially at the provider level Pre ACA O 2000 Surgeon General s report showing ethnic and racial disparities in tobacco use and access to mental health services Minority Health and Health Disparities Research and Education Act of 2000 First major legislation focused on reducing disparities The National Center on Minority Health and Health Disparities 2010 Dept of Health and Human Services developed a plan to reduce racial and ethnic disparities 220 goal to achieve health equity eliminate disparities and improve the health of all groupsquot 0 Community based interventions o Culturally and linguistically appropriate services I Other actions by state local communities private organizations and providers Racial and Ethnic Approaches to Community Health REACH outreach cultural competency training and education 0 Funded by CDC states local health departments universities nonprofits 0 Reduce neighborhood disparities Cultural quality collaborative 0 Network of healthcare organizations 0 Crossculturalintractsion Have these interventions been successful 0 Unclear hard to measure Policy approaches ACA 0 Medicaid expansion 0 Increased funding for cultural competence training 0 Data collection for all federally funded programs to collect information on race ethnicity primary language Increased research support Preventioin and public health initiatives Workforce diversity Increased funds for community health centers 0000 But will these strategies work Cultural competency for providers American College of Physicians 2004 0 Address healthcare disparities on 6 fronts I Increased access to quality healthcare ACA I Patient care and provider issues Culturally competency Clear communication language barriers 0 Systems that deliver care I Connect to the community I Managed care I Language 0 Societal concerns I More diverse workforce of medical students I Minority communities 0 Continued research Theory is Great but in Practice Beagan article Effects of teaching social and cultural awareness to medical students 0 Course addressing social and cultural issues to medical students 0 Results students concluded that learning about social and cultural issues made little or no differencequot I Medical training encourages social neutrality I Medical students ignorant of diversity of classmates focused on individual differences 0 Footnotes I Social neutrality color blind gender blind class blind I Students affected more by own group membership students part of minorities or religious groups were more likely to say that race and culture mattered 0 It s just not an issuequot issues of diversity occur in redneck or uneducated places NOT medical school I Discrimination acknowledged but ultimately it made no differencequot I No time to practice socially and culturally sensitive medicine Group discussion what did the beagan article teaching social and cultural awareness to medical studentsquot suggest about challenges to reduce disparities in healthcare Do you agree disagree Why How could it improve 0 Bigger hurdle can t teach to solve a prob if people don t know or think there s a problem in the first place 0 Bedside manner 0 Cultural competency vs cultural humility Is this problem pervasive among physicians in general 0 Rarely see graph Major Reasons why there are racial ethnic disparities in health Care system 0 30 of doctors said the health system often treated people unfairly based on race ethnicity Perspectives of Physicians of Different Racial Ethnic backgrounds 0 White doctors are more likely than African American and Latno doctors to attribute this to not enough doctors being available in minority communities and less likely than African American Asian and Latino physicians to attribute these disparities to doctors assumptions about minority patients ability to pay for care Physicians of different races and ethnicities have different views on how often disparities in care happen 0 Especially regarding the last question Policy Impliciations o How could this idea of neutrality among medical students be altered if ou think it should 0 What does Beagan suggest I Address power relations not just social and cultural differences I Recognize their own biases I Other thoughts
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