1 HEALTH DISPARITIES IMPACTING RACIAL AND ETHNIC MINORITIES IN MICHIGAN CONTRIBUTORS: BUREAU OF...

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HEALTH DISPARITIES IMPACTING RACIAL AND ETHNIC MINORITIES IN

MICHIGAN

CONTRIBUTORS: CONTRIBUTORS: BUREAU OF EPIDEMIOLOGY BUREAU OF EPIDEMIOLOGY

BUREAU OF FAMILY, MATERNAL, BUREAU OF FAMILY, MATERNAL,

AND CHILD HEALTHAND CHILD HEALTH

DIVISION OF CHRONIC DISEASE AND DIVISION OF CHRONIC DISEASE AND

INJURY CONTROL INJURY CONTROL

DIVISION OF HEALTH, WELLNESS AND DISEASE DIVISION OF HEALTH, WELLNESS AND DISEASE CONTROL CONTROL

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To increase awareness of health disparities by collecting and disseminating relevant data

Decrease the burden of disparities by distributing information on public health interventions with proven effectiveness

Establish a systematic approach to collaboration and communication among governmental, private and community based health entities

Leverage resources to initiate new and innovative programs

Purpose of Health Disparities Initiatives

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“The test of progress is not whether we add more to the abundance of those who have much, it is whether we provide enough for those who have little”

Franklin Delano Roosevelt

Elimination of Health Disparities Became significant concern in 1998Became significant concern in 1998 Six health categories: adult Six health categories: adult

immunization,immunization,

cardiovascular care, cancer care, cardiovascular care, cancer care, diabetes, HIV/AIDS and infant diabetes, HIV/AIDS and infant mortalitymortality

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What is a Health Disparity?

HealthHealth: A state of complete physical, mental : A state of complete physical, mental and social well-being and not merely the and social well-being and not merely the absence of disease or infirmity. (World absence of disease or infirmity. (World Health Organization)Health Organization)

DisparityDisparity: A chain of events signified by a : A chain of events signified by a difference in (1) environment; (2) access to, difference in (1) environment; (2) access to, utilization of, and quality of care; (3) health utilization of, and quality of care; (3) health status; or (4) a particular health outcome that status; or (4) a particular health outcome that deserves scrutiny.deserves scrutiny.

Carter-Pokras & Baquet, Public Health Reports, Sept/Oct, 2002

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Health Disparities

Disparities in health, which refer to differences in health outcomes and status; and

Disparities in health care, which refer todifferences in the preventative, diagnosticand treatment services offered to people with similar health conditions, as well as, health care access.

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Contributing Factors

PovertyPoverty Education LevelEducation Level Cultural Attitudes, Norms, and Values Cultural Attitudes, Norms, and Values Minority Mistrust of Healthcare SystemMinority Mistrust of Healthcare System LanguageLanguage

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Contributing Factors (cont.)

Provider Cultural CompetencyProvider Cultural Competency

““Health is really a social transaction that has a Health is really a social transaction that has a scientific base. You need to have doctors who have scientific base. You need to have doctors who have the basic knowledge, but that alone is not enough. the basic knowledge, but that alone is not enough. You have to have a physician that is able to You have to have a physician that is able to communicate in a way a patient understands.”communicate in a way a patient understands.”Dr. Louis Sullivan, former U.S. Secretary of Health and Human ServicesDr. Louis Sullivan, former U.S. Secretary of Health and Human Services

Stereotypes held by Healthcare ProvidersStereotypes held by Healthcare Providers Access to Health CareAccess to Health Care

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Contributing Factors (Continued)

ACCESS to Health CareACCESS to Health Care

45.8 million Americans (15.7% of the total population) 45.8 million Americans (15.7% of the total population) lacked health insurance in 2005.lacked health insurance in 2005.

• Minorities are more likely than whites to be uninsuredMinorities are more likely than whites to be uninsured 32.7% of Hispanics are uninsured32.7% of Hispanics are uninsured 29.9% of Native Americans and Alaska Natives are uninsured29.9% of Native Americans and Alaska Natives are uninsured 19.6% of African-Americans are uninsured19.6% of African-Americans are uninsured 17.9% of Asians are uninsured17.9% of Asians are uninsured 11.3% of white non-Hispanics are uninsured11.3% of white non-Hispanics are uninsured

7.8% of Michigan residents, or almost 800,000 people are 7.8% of Michigan residents, or almost 800,000 people are uninsured at any one time. uninsured at any one time.

State Planning Project for the Uninsured 2005; U.S. Census Bureau 2005

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“The moral test of government is how it treatsthose who are in the dawn of life, the children;those who are in the twilight of life, the aged; and those who are in the shadows of life, the sick, the needy and the handicapped”

Hubert H. Humphrey

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Disparities Across the Spectrum

Infant Mortality

Black infant deaths occur

almost 3 times more often than

White infant deaths

Prostate

Cancer

Black male deaths occur

2 times more often than White

male deaths

HIV/AIDS

The rate of HIV infection among Blacks is over 8

times higher than the rate

among Whites

Source: Vital Records & Health Data Development Section, Michigan Department of Community Health

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Distribution of Michigan's Population Distribution of Michigan's Population by Race/Ancestryby Race/Ancestry

Demographic Profile

Race/AncestryRace/Ancestry 19801980 19901990 20002000 20052005 % Change% Change

WhiteWhite 85.885.8 84.284.2 80.280.2 80.080.0 -6.8-6.8

BlackBlack 13.013.0 14.014.0 14.214.2 14.014.0 7.77.7

American American IndianIndian

0.50.5 0.60.6 0.60.6 0.60.6 20.020.0

Asian/Pacific Asian/Pacific Islander/ OtherIslander/ Other

0.70.7 1.21.2 3.13.1 3.83.8 442.9442.9

Multi-RacialMulti-Racial N.A.N.A. N.A.N.A. 1.91.9 1.61.6 N.A.N.A.

HispanicHispanic 1.71.7 2.22.2 3.33.3 3.83.8 123.5123.5

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White males White females

Black males Black females

Michigan Life Expectancy

1950 2005

52

57

62

67

72

77

82

52

57

62

67

72

77

82

66.2

60.4

71.9

63.4

75.8

68.0

80.1

75.1


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0102030405060708090

100

15 20 25 30 35 40 45 50 55 60 65 70 75

Percent Surviving to 65 (2003):

White Female 88.0 White Male 81.5

Black Female 76.9 Black Male 63.4

Age

Perc

en

t S

urv

ival

Survival Curve Ages 15-75 by Sex and Race, Michigan Residents, 2005


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Racial and Gender Disparities in Selected Risk Factors for Chronic Disease,

Michigan, 2005

Per

cent

of

p op u

lat i

o n w

i th

risk

Source: Michigan Behavior Risk Factor Surveillance System

10.3

27.5

32.936.3

12.5

21.2

38.7

34

8.3

22.326.627.4

7

19.624.2

26.6

0

5

10

15

20

25

30

35

40

45

HBP Diabetes Smoking Obesity

Black Males Black Females White Males White Females

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Cancer

A diverse group of diseases A diverse group of diseases

characterized by uncontrolled characterized by uncontrolled

growth and spread of abnormal cellsgrowth and spread of abnormal cells

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Breast Cancer Incidence and Mortality by Race

*Adjusted to 2000 US standard population.

32.9

113.2123.3

23.7

0

20

40

60

80

100

120

140

Incidence 2003 Mortality 2003

BlackWhite

Age

-adj

uste

d ra

te p

er 1

00,0

00*


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Cervical Cancer Incidence and Mortality by Race


3.1

11.7

6.6

1.7

0

2

4

6

8

10

12

14


BlackWhite

Age

-adj

uste

d ra

te p

er 1

00,0

00*


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Colorectal Cancer Incidence and Mortality by Race


22

55.7

15.2

44.9

0

10

20

30

40

50

60


Black

White

Age

-adj

uste

d ra

te p

er 1

00,0

00*


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Lung Cancer Incidence and Mortality by Race


94.5

68

54.9

72.8

0102030405060708090

100


BlackWhite

Age

-adj

uste

d ra

te p

e r 1

00,0

00*


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Prostate Cancer Incidence and Mortality by Race


44.7

273.8

23.6

159.5

0

50

100

150

200

250

300


BlackWhite

Age

-adj

uste

d ra

te p

er 1

00,0

00*


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Cardiovascular DiseaseAny disease that affects the heart or Any disease that affects the heart or

bloodblood

vessels by restricting the flow of blood.vessels by restricting the flow of blood.

22Source: Vital Records & Health Data Development Section, Michigan Department of Community Health

Age-Adjusted Stroke Death Rates by RaceMichigan Residents, 1980-2005

0

20

40

60

80

100

120

140

Per

100

,000

Pop

ulat

ion

White

Black

23Source: Vital Records & Health Data Development Section, Michigan Department of Community Health

Age-Adjusted Heart Disease Death Rates by RaceMichigan Residents, 1980-2005

0

100

200

300

400

500

600

Per

10

0,0

00

Po

pu

lati

on

WhiteBlack

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DiabetesDiabetes A chronic disease characterized by theA chronic disease characterized by theinability to use the glucose in food forinability to use the glucose in food forenergy. energy.

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Prevalence of Diabetes by Race/Ethnicity, Michigan & U.S.

Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005. 002 data; CDC. (2004) National Diabetes Fact Sheet ; Diabetes Care, July, 2003

Race/AncestryRace/Ancestry US 2005US 2005 MI 2005MI 2005

WhiteWhite 6.8%6.8% 7.6%7.6%

BlackBlack 11.4%11.4% 12.0%12.0%

HispanicHispanic 6.6%6.6% 8.5%8.5%

OtherOther 7.2%7.2% 5.0%5.0%

Multi-RacialMulti-Racial 8.3%8.3% 9.6%9.6%

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Deaths Due to Diabetes per 100K

DeathDeath U.S. U.S. 20032003

MI 2003MI 2003 MI MI 20052005

White - White - PrimaryPrimary

CauseCause

23.023.0 24.224.2 24.724.7

Black - PrimaryBlack - Primary

CauseCause49.249.2 38.438.4 40.040.0

White - Any White - Any MentionMention

N.A.N.A. 74.974.9 76.376.3

Black – Any Black – Any MentionMention

N.A.N.A. 116.8116.8 124.5124.5Source: Vital Records & Health Data Development Section, Michigan Department of Community Health

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HIV/AIDS

HIV: Human Immunodeficiency VirusHIV: Human Immunodeficiency Virus

Transmission: Unprotected Anal/Vaginal/Oral SexTransmission: Unprotected Anal/Vaginal/Oral Sex Needle Sharing Needle Sharing

Maternal Maternal

AIDS: Acquired Immune Deficiency SyndromeAIDS: Acquired Immune Deficiency Syndrome

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Prevalence Estimates of Persons Living with HIV/AIDS in MI by Sex and Race as of October 1, 2006

0

1000

2000

3000

4000

5000

6000

7000B

lac

km

ale

s

Wh

ite

ma

les

Bla

ck

fem

ale

s

Wh

ite

fem

ale

s

His

pa

nic

ma

les

His

pa

nic

fem

ale

s

Pre

vale

nc

e E

sti

ma

te

MDCH/Bureau of Epidemiology/HIV/AIDS Surveillance Program

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HIV Related Deaths in MI, all ages, by Race & Sex, 1990-2005*

050

100150200250300350400450500

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

*

Year of Death

Nu

mb

er

of

De

ath

s

White Males Black MalesWhite Females Black Females

*Deaths for 2005 may be incomplete.

MDCH/Bureau of Epidemiology/HIV/AIDS Surveillance Program

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Infant Mortality The number of deaths occurring in children under the age of one year.

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Race specific Infant Mortality Rate Michigan compared to US

0

5

10

15

20

25

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Per

1,0

00 li

ve b

irth

s

Black MI Black USWhite MI White US


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Eliminating Disparities

“We cannot become what we need to be by remaining what we are” Max Depree

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General Recommendations New knowledge about the determinants of disease

Develop infrastructure capacity of community-based organizations

Programs must emphasize behavioral risk-reduction and other prevention strategies

Communities must assist at-risk individuals in accessing programs designed to diagnose and treat conditions early

Greater role of local leaders including faith-based and fraternal organizations

Community level interventions to promote normative change

Evidence-based strategies

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General Recommendations (Cont.) Public Health safety net

Integration of healthcare services, one stop shopping Development of comprehensive community health

centers

Comprehensive health screening programs for communities of color

Culturally and gender appropriate skills-building workshops

Mobile Outreach

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Specific Groups Recommendations1.1. Schools (K-12):Schools (K-12): Add prevention messages to MI Model Add prevention messages to MI Model

for Comprehensive School Health Education for Comprehensive School Health Education Curriculum. Urge the adoption of policies on healthy Curriculum. Urge the adoption of policies on healthy foods and beverages.foods and beverages.

2.2. Higher Education:Higher Education: Increase number of ethnically Increase number of ethnically diverse/culturally competent providers diverse/culturally competent providers (Michigan Diabetes Strategic Plan recommendations, 2003)(Michigan Diabetes Strategic Plan recommendations, 2003)

3.3. Business:Business: Create work-based risk-reduction, screening, Create work-based risk-reduction, screening, self-management education among employer/union self-management education among employer/union groupsgroups

4.4. HealthcareHealthcare: Support programs that serve minority : Support programs that serve minority populations; Promote culturally acceptable prevention populations; Promote culturally acceptable prevention disease managementdisease management

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Specific Groups Recommendations (Cont.)

5.5. Healthcare OrganizationsHealthcare Organizations: Partner with professional : Partner with professional organizations to improve awareness, knowledge and skills organizations to improve awareness, knowledge and skills among health care providersamong health care providers

6.6. Community OrganizationsCommunity Organizations: Promote messages and use of : Promote messages and use of lay health workers among faith-based and other community lay health workers among faith-based and other community organizationsorganizations

7.7. State Government:State Government: Target funding to reduce health Target funding to reduce health disparities (Michigan Diabetes Strategic Plan disparities (Michigan Diabetes Strategic Plan recommendations, 2003)recommendations, 2003)

8.8. Media’s Role:Media’s Role: Implement statewide public awareness Implement statewide public awareness campaign of health disparitiescampaign of health disparities

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Of all the forms of inequality, Of all the forms of inequality, injustice in health care is the most injustice in health care is the most shocking and inhumane.shocking and inhumane.

Martin Luther King Martin Luther King Jr.Jr.

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Health Disparities Work Group

Audrea M. Woodruff, ChairpersonAudrea M. Woodruff, ChairpersonActing Manager, HDRMHActing Manager, HDRMH

Fawzie AhmedFawzie Ahmed Sheila EmbrySheila EmbryRhonda Bantsimba Rhonda Bantsimba Sophia HinesSophia HinesBrandon Boyle Brandon Boyle Jacquetta Hinton Jacquetta Hinton Patricia Brookover Patricia Brookover Erma Leaphart-GouchErma Leaphart-GouchAlethia Carr Alethia Carr Henry MillerHenry MillerJean C. ChabutJean C. Chabut Amy SlonimAmy SlonimRobert Cochran Robert Cochran Debra SzwejdaDebra SzwejdaArthur DavisArthur Davis Jada WilliamsJada WilliamsDaniel Diepenhorst Daniel Diepenhorst Paulette Dobynes Dunbar Paulette Dobynes Dunbar Konrad EdwardsKonrad Edwards

Dr. Kimberlydawn Wisdom, Surgeon GeneralDr. Kimberlydawn Wisdom, Surgeon General

Dr. Kimberlydawn Wisdom, Surgeon GeneralDr. Kimberlydawn Wisdom, Surgeon General

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1 HEALTH DISPARITIES IMPACTING RACIAL AND ETHNIC MINORITIES IN MICHIGAN CONTRIBUTORS: BUREAU OF...

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