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Health Disparities: A Brief Overview LAUREN L. JOSEPHS, PHD, LMHC, NCC
Health Disparities: A Brief Overview
LAUREN L . JOSEPHS, PHD, LMHC, NCC
Health Disparity Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.
Populations can be defined by factors such as race or ethnicity, gender, education or income, disability, geographic location (e.g., rural or urban), or sexual orientation.
Source: CDC. Community Health and Program Services (CHAPS): Health Disparities Among Racial/Ethnic Populations. Atlanta: U.S.
Department of Health and Human Services; 2008
Health Disparity Health disparities are inequitable and are directly related to the historical and current unequal distribution of social, political, economic, and environmental resources.
Health disparities result from multiple factors, including ◦ Poverty
◦ Environmental threats
◦ Inadequate access to health care
◦ Individual and behavioral factors
◦ Educational inequalities
Health Care Disparity IOM defines health care disparities as “racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention.”
Disparities remain even when insurance status, income, age, co-morbid conditions, and symptom expression are controlled.
Source: Stith AY, Nelson AR. Institute of Medicine. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Board on Health Policy, Institute of Medicine. Washington, DC: National Academy Press; 2002. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.
FL Health Disparities Focus Areas
Florida has 7 Disparity Focus Areas:
Cancer
Cardiovascular Disease
Diabetes
Adult and Child Immunizations
HIV/AIDS
Maternal and Infant Mortality
Oral Health Mental Health is an overlooked health disparity focus area
How do disparities arise? Differences in the quality of care received within the health care system
Differences in access to health care, including preventive and curative services
Differences in life opportunities, exposures, and stresses that result in differences in underlying health status
Key Findings of the 2014 NHQDR While the US has made clear progress in improving the health care delivery system there is still more work to do, specifically to address disparities in care. ◦ Access improved.
◦ Quality improved for most National Quality Strategy priorities.
◦ Few disparities were eliminated.
◦ Many challenges in improving quality and reducing disparities remain.
NHQDR 2014
Disparities in quality of care are common:
The 2014 QDR demonstrates that access to care improved.
After years of stagnation, rates of uninsurance among adults decreased in the first half of 2014 as a result of Affordable Care Act insurance expansion. However, disparities in access to care, while diminishing, remained.
Source: 2014 National Healthcare Quality & Disparities Report
QUALITY DISPARITIES: Overall quality (top map) and racial/ethnic disparities (bottom map) varied widely across states and often not in the same direction
Overall Quality
Racial/Ethnic Disparities
ACCESS: Between 2002 and 2012, access to health care improved for children but was unchanged or significantly worse for adults
People who needed care right away for an illness, injury, or condition in the last 12 months who sometimes or never got care as soon as wanted
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2012.
0
10
20
30
40
50
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Pe
rce
nt
Children, Any Private Children, Medicaid/CHIP Only Adults 18-64, Any Private
Adults 18-64, Medicaid Only Adults 18-64, Uninsured
People who made an appointment for routine health care in the last 12 months who sometimes or never got an appointment as soon as wanted, by age and
insurance, 2002-2012
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10
20
30
40
50
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Pe
rce
nt
Children, Any Private Insurance Children, Medicaid/CHIP Only
Adults 18-64, Any Private Insurance Adults 18-64, Medicaid Only
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2012.
NHQDR 2014
Few disparities were eliminated.
People in poor households generally experienced less access and poorer quality.
Parallel gains in access and quality across groups led to persistence of most disparities.
At the same time, several racial and ethnic disparities in rates of childhood immunization and rates of adverse events associated with procedures were eliminated, showing that elimination is possible.
Source: 2014 National Healthcare Quality & Disparities Report
Orange County Demographic Information
Census Information (2010) showed
Foreign Born -19.4%
White - 69%
Non-Hispanic White- 43.3%
Hispanic/Latino -29.2%
Black/Afr. American -22%
Asian – 5.6%
American Indian/ Alaska Native – 0.6%
Native Hawaiian/ Other PI- 0.2%
Two or More Races – 2.5%
Lang. other than Eng. spoken at Home- 34%
SOURCE: US CENSUS/ACS 2014 13
Low Wages Metropolitan Orlando is the only community in America where the majority of jobs pay less than $30,000 a year.
Nearly 40% of jobs pay less than $25,000.
We are #1 for jobs paying $20,000
Source: US Bureau of Labor Statistics, 2015
Social Determinants
The social determinants of health are mostly responsible for health inequities.
The structural roots of health inequities lie within education, taxation, labor and housing markets, urban planning, government regulation, health care systems, all of which are powerful determinants of health, and ones over which individuals have little or no direct personal control but can only be altered through social and economic policies and political processes. (WHO Commission on the Social Determinants of Health)
Addressing Health Disparities What can you do within your Organizations?
Disaggregate Program Data
Ensure the use of Culturally appropriate screening and assessment tools
Utilize innovative, cultural-specific outreach and engagement efforts
Involve youth and family in the feedback loop
Be responsive to individuals with Limited English Proficiency
Address Cultural Variances
Incorporate Cultural and Linguistic Competence during the CQI process.
Mortality at Titanic by passenger class, men and women
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1st 2nd 3rd . 1st/2nd 3rd
Passenger class
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From Broom L & Selznick P, 1968
Women Children
Contact Me Lauren Josephs, PhD, LMHC, NCC
Visionary Vanguard Group, Inc.
1221 W. Colonial Dr.
Ste. 202
Orlando, FL 32804
(407)496-6945 (Mobile)
(407)896-2066 (Office)
