RACE ETHNICITY & HEALTH
RACE ETHNICITY & HEALTH HLTH 236
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Date Created: 10/21/15
Health 236 Exam 1 Review Race Social Category physical appearance due to particular historical social and political forces focused on physical characteristics Ethnicity social category shared cultural identity with distinct behavioral characteristics focused on common cultural traits Nationality membership to a nation or sovereign state citizenship place of residency sense of national identity Health Disparities incidence prevalence mortality and burden ofdisease within a population Health Care Disparities differences in the presence of illness health outcomes or access to care within a population Inequality in Health differences in both health experience and health status between countries regions states and socioeconomic groups lnequity in Health systematic unfair or unjust yet potentially avoidable differences in access to health services across de ned population groups Determinants of health factors which directly cause illness and disease or are risk factors that affect the health or a population community or individual socioenvironmental factors physical environmental factors individual factors access to health services Mortality number of deaths within a population Crude Mortality Rate total number of deaths within a time period cannot be compared Causespecific Mortality attributed to a particular cause disease or illness Agespecific Mortality specific age group Infant Mortality Rate infants under the age of 1 probability of dying between birth and exactly one year of age expressed per 1000 live births number of infant deaths among infants 0365 days at a given period of time divided by the population size at midpoint times of multiplier generally 1000 Life Expectancy average years a person can expect to live a healthy productive lifestyle that is determined at a particular age Morbidity number of individuals with a disease illness injuries and disabilities within a population number of ill individuals among a group of people at risk forthe illness at a given time Incidence number of persons contractingnew cases of disease Prevalence number of persons who have all cases a particular disease condition Socioeconomic Status measure of social and economic characteristics that typically include measures of income poverty level wealth education work statusoccupation place of residence Plessy vs Ferguson 1896 endorsed the development of state and local Jim Crow laws requiring the separation of the races WEB DuBois published The Philadelphia Negro used social science methods to describe social and economic conditions that shaped the quality of life and health status ofAfrican Americans Booker T Washington founder and president of Tuskegee Institute in Alabama Negro Health Improvement Week was launched in 1915 Became so successful that round 1932 it was adopted by the US Public Health Service as part ofthe new federal Of ce of Negro Health Works 1951 however the Of ce of Negro Health Works was decommissioned in the name of integration Slavery African Americans arrived in 1619 lasted 244 years Tuskegee 19321972 Macon County Alabama 600 black men 399 with Syphilis and 201 without disease withheld adequate treatment from a group of poor black men who had the disease told the men they were being treated for bad Blood men received free medical exams free meals and burial insurance summer of 1973 a classaction lawsuit filed by the national Association for the Advancement of Colored People NAACP Margaret Heckler Secretary of US Department of Health and Human Services Secretary s Task Force Report on Black and Minority Health 10volume documented excess deaths from seven disease conditions cancer cardiovascular diseases chemical dependency diabetes homicide unintentional injuries and infant mortality experienced by African Americans Hispanics Native Americans and Asian andor Pacific Islander and Alaskan Native populations Emancipation Proclamation after more than 240 years of slavery President Abraham Lincoln issued the Emancipation Proclamation on January 11863 announcing that all persons held as slaves within the rebellious areas are and hencefonNard shall be free 13 Amendment ratified in 1865 outlawed slavery in the US and all territories 14 Amendment paved the way equal educational opportunities with the Supreme Court s declaration in Brown Vs Board of Education that racially segregated schools violate the equal protection ofthe laws guaranteed by the Fourteenth Amendment 15 Amendment Male Voting rights however a plethora of insidious methodologies for preventing African Americans from exercising their voting rights were successfully implemented by racist whites who dominated the corridors leader to the voting booths voter qualifying tests literacy tests discriminatory enforcement of registration rules poll taxes and outright racial gerrymandering Civil Rights Act of 1964 prohibited discrimination in public accommodations such as mass transportation restaurants and hotels on the basis of race color religion or national origin shifted government policy away from the support of racially discriminatory social norms Voting Rights Act 1965 eliminated discriminatory election practices and suspended literacy tests and provided for the appointment of federal examiners this and the CRA dismantled the most limiting components of the Jim Crow Laws and fulfilled the constitutional guarantees contained in the 14 and 15 amendments 19 Amendment guaranteed all American women the right to vote Directive 15 Office of Management and Budget OMB issued in 1977 the Race and Ethnic Standards for Federal Statistics and Administrative Reporting contained in Statistical Policy Directive No 15 Directive 15 is an attempt to standardize data collection so that comparisons of races could be made by creating categories to classify individuals Importance of Studying Minority Health the public cost of disparities the costs of health disparities to business Direct Costs Indirect Costs NCMHD National Center on Minority Health and Health Disparities lead coordinate support and asses the NI effort to eliminate health disparities research research infrastructure public information and community outreach Neonatal Mortality Rate number of deaths during the rst 28 completed days of life per 1000 live births in a given year or other period Post Neonatal Mortality Rate rate of newborns dying between 28 and 364 days old Socioeconomical model intrapersonal interpersonal organizational community public policy Incidence Rates the rate a disease develops in a group of people over a certain period oftime number of new cases divide the number of new cases by the number of people at risk and multiply Prevalence Rates number of existing cases of a disease in a population at some designated time divide number of cases by total number in population at a given time Specific Rate strati ed rates Adjusted Rates statistical procedures applied to make crude rates more comparable Mortality Crossover mortality rates that illustrate two groups of individuals vary in one way for younger versus older individuals Comparative Mortality crude mortality rates cannot be compared age adjusted and speci c mortality rates can be compared more accurately Acute shortterm Chronic longterm Birth Rates Number of live births at a given time divide the of live births in selected time by the population size at midpoint ofa selected time period then multiply YPLL Years of Potential Life Lost the number of years that are lost due to untimely death base upon average life expectancy does not include quality of life in the calculation 3 Determinants of Health Behavior and Lifestyle Environmental Exposure Healthcare Low SES and Health increased morbidity and mortality More likely to suffer from mental disorder Martial distress and disrupted parenting 0 Children with depression substance abuse behavior problems Barriers 0 Health care child care transportation etc Closing the Gap on SES Disparities providing health coverage Improving economic conditions Increasing educational opportunities Introducing culturally sensitive health promotion efforts Implicit Health Behavior implied or understood though not directly expressed Contained in the nature of something though not readily apparent Explicit Health Behavior clearly developed or formulated Fully and clearly expressed or demonstrated Preventative Behaviors Primary 0 Strategies used to avoid diseases EX Vaccinations Secondary 0 Early diagnosis and treatment of existing disease andor health condition in order to avoid further debilitative effects EX Screenings Self BE for and pap smears for carnival cancer Aim catch it early to avoid advancement Tertiary 0 Fighting the disease andor health condition when signssymptoms present to minimize complications EX Medication therapy adherence changing dietexercise program Quaternary o Avoidance of overtreatment Illness Behaviors Behaviors people engage in with the aim of relieving effects of illness lllness behaviors strongly liked to sociodemographic factors such as 0 Gender utilization of medical services high in women than men 0 Ethnicity utilization of medical services lower among Hispanics and Blacks compared to Whites and Asians 0 Education Social classincome utilization of medical services greater among higher SES than lower 0 Family Structure 0 Risk Behaviors behaviors which are associated with increased risksusceptibility to adverse health consequences illness injury Healthy People 2020 exploring these questions by developing objectives that address the relationship between health status and biology individual behavior health services social factors and policies and emphasizing an ecological approach focuses on both individuallevel an populationlevel determinants of health and interventions Determinants of Health Policy Making Social Factors Health Services Individual Behavior Biology an Genetics Policy Making Policies at the local state and federal level affect individual and population health Increasing taxes on tobacco sales for example can improve population health by reducing the number of people using tobacco products Social Factors social determinants of health reflect social factors and the physical conditions in the environment in which people are born live learn play work and age Also known as social and physical determinants of health they impact a wide range of health functioning and quality of life outcomes Poor health outcomes are often made worse by the interaction between individuals and their social and physical environment Health Services Bother access to health services and the quality of health services can impact health Healthy People 2020 directly addresses access to health services as a topic area and incorporates quality of health services throughout a number of topic areas Lack of access or limited access to health services greatly impacts an individual health states For example when individuals do not have health insurance they are less likely to participate in preventative care and are more likely to delay medical treatment Individual Behavior plays a role in health outcomes Example fan individual quits smoking his or her risk of developing heart disease is greatly reduced Biology and Genetics Some biological and genetic factors affect speci c populations more than others Example older adults are biologically prone to being in poorer health than adolescents due to the physical and cognitive effects of aging Disparity those differences that are indicative of injustice or unfairness Dissimilarities differences that are not attributed to injustice or unfairness Health Disparities A particular type of health difference that is closely linked with social economic andor environmental disadvantage Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group religion socioeconomic status gender age mental health cognitive sensory or physical disability sexual orientation or gender identity geographic location or other characteristics historically linked to discrimination or exclusion Health Care Disparities refers to differences specifically within the healthcare system access to health care quality of health care and utilization of health care services that are a result of injustice Health Care Dissimilarities refers to the same differences within the health care system access to health care quality of health care and utilization of health care services that are NOT a result of injustice 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 Health Care Utilization Enabling Factors Predisposing Factors Perceived need for Health Care Services Enabling Factors Are resources that either facilitate or inhibit someone seeking health care services EX having a car is a facilitating factor because it provides transportation a useful resources for physically traveling to a health care provider Having no health insurance would be an inhibiting factor because ot often deters one from seeking health care services Predisposing Factors Are an individual s inclination to use health services most notably one s attitudes toward using health care These attitudes may be facilitating or inhibiting and are largely influences by cultural beliefs and prior expenences EX If someone distrusts the medical establishment or has had negative experiences with the medical establishment heshe may be less likely to seek health care services Conversely if one has a great relationship with a medical provider heshe is more likely to continue visiting this provider in the future Perceived need for Health Care Service s one s belief that heshe does or does NOT need to utilize health care services for health issues fone does not perceive a need for an action including health behaviors heshe is much less likely to engage in that behavior Leading Causes of Death For whites blacks American Indians Alaskan Natives and Latinos heart disease is the leading cause of death and malignant tumors cancer is the second leading cause of death For Asians and Pacific Islanders malignant tumors is the leading cause of death while heart disease is the close second Theories of Health Disparities SocioEnvironmental Theories 0 Risk Exposure Theory says that high prevalence of social or environmental health risks in predominantly minority communities lead to a higher prevalence of disease and death Because the US is a highly racial segregated country different rates of health risk in different communities place different populations at different levels of risk in those communities 0 Resource Deprivation Says that racialethnic disparities in health status exist because minorities are more likely than whites to live in communities that are lacking in the necessary infrastructure to support a healthy lifestyle 0 Infrastructure includes road ways food sources safety and health care services PsychologicalBehavioral Theories o Weathering Exposure Seeks to explain the differences between AfricanAmericans and Whites in pregnancy outcomes The Weathering Hypothesis proposes that social stress in the community in the environment and the society affects African Americans and other minorities negatively Specifically these populations are said to actually weather or age at accelerated rates because of increased exposure to stress We know that excess stress has numerous health implications including premature aging and associated conditions 0 John Henryism Developed by Sherman James a psychologist who was trying to understand why African Americans have such high rates of hypertension The John Henryism hypothesis assumes that lower SES individuals in general and African Americans in particular are routinely exposed to psychosocial stressors chronic financial strain job insecurity and subtle or not so subtle social insults linked to race or social class that require them to use considerable energy each day to manage the psychological stress generated by these conditions The hypothesis further assumes that individuals exposed to excess psychosocial stressors will respond differently with varying degrees of success The John Henry Hypothesis predicts that individuals in lower SES categories who utilize active coping skills related to the excess stressors are more likely to suffer from hypertension due to their effort Physiological Theories 0 Genetic differences among racialethnic populations