Week 2 Lecture Notes
Week 2 Lecture Notes 309
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This 10 page Class Notes was uploaded by Joycelyn R. Hutton Jr. on Friday October 23, 2015. The Class Notes belongs to 309 at Syracuse University taught by M. Thompson in Summer 2015. Since its upload, it has received 10 views. For similar materials see Health Disparities in Nutrition and Food Sciences at Syracuse University.
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Date Created: 10/23/15
Hutton Joycelyn 8 September 2015 HTW 309 Week 2 Notes Individual Liberties versus the Common Good 1 Questions a Do historical American Values qualities stand in the way of reducing inequalities observed today in modern US society b Individual liberty versus the common good i Do individuals have the right to do anything that they please ii Should the community government limit individual liberties for the common good of others c Origins of good health i Are individuals primarily responsible for their own health ii What role does the government or community have in promoting health of residents 2 American Values a Historical roots b Determination The American Dream c Individualism versus conformity me versus we d Competitiveness versus cooperation e Majority rules versus consensus building f Autonomy versus dependency g Video YouTube Think Well Part one and two Individual Liberty vs The Common Good 3 Ethical Norms and Values Origins of Health Hutton Joycelyn 8 September 2015 HTW 309 a Individual perspective i Values autonomy individual liberty individual rights ii Good health is viewed as a function of personal lifestyle choices iii Poor health results because individuals fail to assume adequate responsibility for their health and well being b Community or common good perspective i Values reciprocity trust social obligation individual sacrifices at times ii Focuses on the differential health risks that exist as a function of the availability of opportunities and resources for maximizing health iii Poor health results because communities fail to invest in and assume responsibility for the collective wellbeing of their members c Market justice i Reflects the economic principles of supply and demand ii Individual resources and choices determine the distribution of goods 39i The ability to pay is the rationing criteria v Little if any role for governments 4 Marketjustice and health care a Deep historical roots in the US i Until the mid19th century both buyers and sellers participated in a fully functional market ii Buyers predominantly used personal funds to purchase health care b Today buyers predominantly use insurance to purchase health care i Health care competes for consumers Hutton Joycelyn 8 September 2015 HTW 309 ii Those who can afford better or additional care buy it c Distributive justice i Equal distribution of goods and services ii How do we allocate our finite health care resources in ways that are socially just 5 Two competing forces in democratic societies a The right of the individual b Go back to see slide 6 US Health Care system a Clearly rejects pure market justice yet no collective demand that society achieve equity through social justice b Relies on the buffer of insurance to improve access but with minimal attention to quality i Government funded insurance for low income and the elderly Ill ii Constitutiona right to health care for American Indians and those who are incarcerated iii Employer based insurance iv Yet with health care reform we still have 10M without health insurance v Asian Americans are least insured c Has become a valuable commodity that creates influential vested commercial interests with little motive to abandon market justice d Private insurance markets enjoy a healthy profit margin e Multipayer system Hutton Joycelyn 8 September 2015 HTW 309 i Administrative costs of US health care adds billions of dollars to the total cost f Move is toward a blending of distributive and market justice i All should receive the minima standard of health care ii Others may be able to secure additional services via their societal position or personal wealth 7 Autonomy versus the common good role of the States and Federal Government a Public health laws b Legal system i What laws and policies exist in each ii What impact have they had on improving health iii Among the public what resistance if any exists to the universal adoption of these policies Epidemiology Evaluating Disparities Demography 10 September 2015 1 Demography what is it a The study of populations b Interested in size of the population distribution structure and patterns of changes c Alsocharacteristics of populations marriage rates divorce rates age gender race ethnicity income educational achievements as well 2 Data collection Hutton Joycelyn 8 September 2015 HTW 309 a US Census Bureau department of commerce i Decennial census ii American community survey 2000 1 Flawed in the way we collect the data Why Metropolitan area 65k 2 Name sex age ethnic origin race language ability educational attainment and household income iii Current population Survey iv Economic Census 1 Data source of information on the labor force characteristics reports to the bureau of labor v go back to lecture to see details of each one 3 Importance of data collection broadly a Appointment of US House of Rep seats 435 b Allocation of federal state and local funding based on a variety of need variables poverty levels low levels of educational attainment low levels of English literacy c Go back and review 4 Data limitations a Selfreported data b Lack of full participation and hard to get populations make the results undercounted i Minority groups AA Am Indian Alaskan Native ii Low income iii Young children Hutton Joycelyn 8 September 2015 HTW 309 iv Homeless c Small samples sizes particularly in the ACS for some populations render analysis difficult or impossible d Large intrarace and intraHispanic ethnicity variability exists for some races especially Asian American and Native Hawaiian Other Pacific Islander races and the Hispanic Latino ethnic populations making generalizations about these groups difficult 5 US Census Race and Ethnicity Categories a See lecture slides for Census form b See what categories are listed for Race and Ethnicity 6 See US Population Demographic change 20002010 from lecture slides 7 See projected population change by race 20102050 8 US population growth a 2010 i 60 dt natural increase births exceeds deaths ii 40 dt net immigration 1 When considering the children of immigrants net immigration plays a larger role than natural increase higher fertility rate among Hispanics b 2050 i New immigrants and their children will account for 87 of the population growth 20052050 c See geographic distribution for minority populations from lecture slide d Also see the shifts in age distribution i Getting older as a populations Hutton Joycelyn 8 September 2015 HTW 309 e Also see geographic distribution of population ages from lecture slides i See conclusions from this map 9 Aging populations a Increasing numbers i Aging of the baby boomers ii Increase in life expectancy b Rapid growth rate i Rate of growth exceeds that of younger age groups ii Greatest growth in the oldest old group 85 iii Increase in racial and ethnic diversity expected 10 Changing demographic implication for healthcare a Racial and ethnic composition i Persistence of health disparities resulting in greater health care utilization and costs ii Go back and review b Aging pop i Increased demand for health services 1 Go back to see details 2 Aging of the healthcare workforce retire when most needed 3 Declining youth population concerned about new health workers ii Will change the mix of services demanded Hutton Joycelyn 8 September 2015 HTW 309 iii Will have economic implications that could affect future health care coverage policies and the provider reimbursement system c review slide d Geographic location i Healthcare shortage areas there is an increase in urban residents in which there is and will continue to be a concentration of minorities however a sig number of individual will live in rural areas ii Geographic variation in population growth rates and in determinants of health worker demand and supply place disproportionate burdens on state level health care costs 11 Epidemiology a The study of occurrence distribution and control of disease in populations b The study of the distribution c Go back and review 12 Health disparity populations a According to US Public Law 2000 minority health and health disparity research and education Pops in which there is a quotsig disparity difference in the overall rate of disease incidence prevalence morbidity mortality or survival rates in the population as compared to the health status of the general population b Measurement and reporting health disparities i Crude numbers life expectancy US by race see lecture for illustration 13 Does SES alone explain differences in life expectancy Hutton Joycelyn 8 September 2015 HTW 309 a Race and relation to lower SES some racial and ethnic minorities A AN Latinos have less access to income health care and education all factors that affect longevity b However Latinos tend to live longer than whites on average and 8 years longer than blacks go back and review 14 Measurement Continued a Crude numbers can be deceiving when comparing rates of disease deathamong populations of varying overall sizes or ages i Want to look at an adjusted age crude rate for more accurate depiction of effects per demographic Age adjustment a statistical process applied to rates of disease death injuries or other health outcomes that allows communities with different age distributions to be compared Mortality coronary vascular disease by race see table on lecture slide Odds ratio measure of association between an exposure independence variable and an outcome dependent variable i Or 1 no association ii See example on lecture slide of breast cancer mortality by race Is there a disproportionate burden observed in the disadvantaged population i Do incidence rates prevalence rates mortality rates observed in the disadvantaged group exceed the racial ethnic proportion of the general population ii See lecture slides for HIV AIDS incidence rates by race and ethnicity CDC 2008 Hutton Joycelyn 8 September 2015 HTW 309 15 Life expectancy by country and gender WHO 2013 a US fares poorly in international comparisons b Yet spends the most per capita on health care i And thereforego back to see c Explanation lower life expectancy i 25 years prior American life expectancy ranked much higher than it does today 1 See details from slides ii Our health status rankings have stagnated or worsened since the late 1990 s 1 See details from slide 16 Low life expectancy in the US a High infant mortality rates b High mortality among youth via violence c High fatal accident rates d Obesity e Social determinants f Behavioral determinants g See and review from lecture slides