Health Health Disparities Disparities

From knowledge to actionFrom knowledge to action

Overview of DisparitiesOverview of Disparities

Ethnicity

Socioeconomic StatusGeographic location

Overview of DisparitiesOverview of Disparities

Minority Americans report Minority Americans report widespread patient-physician widespread patient-physician communication differencescommunication differences

Minority Americans are more Minority Americans are more likely to feel treated with likely to feel treated with disrespect when obtaining health disrespect when obtaining health carecare

Though the gap is closing Though the gap is closing disparities persist in satisfaction disparities persist in satisfaction with primary and secondarywith primary and secondary carecare

Overview of DisparitiesOverview of Disparities

From : Unequal Treatment; Confronting Racial and Ethnic Disparities in Health care – IOM 2003

Overview of DisparitiesOverview of Disparities

Minority Americans have worse Minority Americans have worse health status and more chronic health status and more chronic conditionsconditions

Minority Americans have lower Minority Americans have lower rates of insurances coverage and rates of insurances coverage and less access to careless access to care

Overview of DisparitiesOverview of Disparities

Disparities are found across a Disparities are found across a range of clinical settings, range of clinical settings, including public and private including public and private hospitals, teaching and non-hospitals, teaching and non-teaching hospitals, etc.teaching hospitals, etc.

Disparities in care are associated Disparities in care are associated with higher mortality among with higher mortality among minorities (e.g., Bach et al., minorities (e.g., Bach et al., 1999; Peterson et al., 1997; 1999; Peterson et al., 1997; Bennett et al., 1995)Bennett et al., 1995)

Overview of DisparitiesOverview of Disparities

Disparities consistently found Disparities consistently found across a wide range of disease across a wide range of disease areas and clinical servicesareas and clinical services

Disparities are found even when Disparities are found even when clinical factors, such as stage of clinical factors, such as stage of disease presentation, co-disease presentation, co-morbidities, age, and severity of morbidities, age, and severity of disease are taken into accountdisease are taken into account

Potential sources of Potential sources of healthcare disparitieshealthcare disparities

Health systems-level factors – Health systems-level factors – financing, structure of care; financing, structure of care; cultural and linguistic barriers.cultural and linguistic barriers.

Patient-level factors – including Patient-level factors – including patient preferences, refusal of patient preferences, refusal of treatment, poor adherence, treatment, poor adherence, biological differences.biological differences.

Disparities arising from the Disparities arising from the clinical encounter.clinical encounter.

Causes of Death (2000) Causes of Death (2000) USAUSA

RankRank WhiteWhite African African AmericanAmerican

HispanicHispanic

11 CardiovascularCardiovascular CardiovascularCardiovascular CardiovascularCardiovascular

22 CancerCancer CancerCancer CancerCancer

33 CerebrovasculaCerebrovascularr

CerebrovascularCerebrovascular Unintentional Unintentional InjuryInjury

44 COPDCOPD Unintentional Unintentional InjuryInjury

CerebrovascularCerebrovascular

55 Unintentional Unintentional injuryinjury

DiabetesDiabetes DiabetesDiabetes

66 PneumoniaPneumonia HomicideHomicide Chronic liver Chronic liver diseasedisease

77 DiabetesDiabetes HIV/AIDSHIV/AIDS HomicideHomicide

Mortality Rates* (All Mortality Rates* (All causes) 2000causes) 2000

AllAll WhiteWhite African African AmericaAmericann

Asian Asian AmericaAmericann

HispanicHispanic

USUS 870.4870.4 849.8849.8 1126.1126.66

516.5516.5 670.1670.1

SoutherSouthern USn US

884.7884.7 838.7838.7 1138.1138.44

435.3435.3 603.5603.5

GeorgiaGeorgia 965.7965.7 915.3915.3 1148.1148.66

530.8530.8 441.6441.6

From National Center for Health Statistics

* - rates reported per 100,000 individuals

Cardiovascular/Cardiovascular/CerebrovascularCerebrovascular

Leading cause of death in Leading cause of death in African American men African American men (33.5%) and women (33.5%) and women (40.6%)(40.6%)

More than twice as likely More than twice as likely to die from hypertensive to die from hypertensive heart diseaseheart disease

Prevalence of high blood Prevalence of high blood pressure one of the pressure one of the highest in the world highest in the world ( worse in the ( worse in the southeastern US)southeastern US)

45% have blood 45% have blood cholesterol levels of > cholesterol levels of > 200 mg/dl 200 mg/dl

36%of African 36%of African Americans have Americans have hypertensionhypertension

African Americans at African Americans at greater risk than greater risk than whites for death from whites for death from both both

Two to three times Two to three times greater risk to have an greater risk to have an ischemic strokeischemic stroke

Higher death rates Higher death rates from stroke Americansfrom stroke Americans

DiabetesDiabetes 2.7 million or 11.4% of all African Americans 2.7 million or 11.4% of all African Americans

more than twenty years old have DM.more than twenty years old have DM. African Americans and Hispanics are twice African Americans and Hispanics are twice

as likely to have DM than non-Hispanic as likely to have DM than non-Hispanic whites. whites.

There is twice the risk of developing heart There is twice the risk of developing heart disease and stroke.disease and stroke.

2 to 4 times the risk of dying from heart 2 to 4 times the risk of dying from heart disease.disease.

One in every four African American women One in every four African American women over 55 years has DM.over 55 years has DM.

HIV/AIDSHIV/AIDS Problem of EPIDEMIC proportion.Problem of EPIDEMIC proportion. African Americans accounted for half of African Americans accounted for half of

the new cases in 2001.the new cases in 2001. More than 168,000 African Americans More than 168,000 African Americans

died of AIDS in 2001. Leading cause of died of AIDS in 2001. Leading cause of death in African American men aged 35-death in African American men aged 35-44.44.

Approximately 78% of HIV infected Approximately 78% of HIV infected women are minorities.women are minorities.

African-American and Hispanic children African-American and Hispanic children accounted for more than 80% of pediatric accounted for more than 80% of pediatric AIDS cases in 2000.AIDS cases in 2000.

Aids Infection byAids Infection by Gender and Race Gender and Race

AfricanAmerican

Whites

Latino

Other

Females Males

64%

17%

17%

43%

35%

20%

Cancer Death Rates, by Cancer Death Rates, by Race and Ethnicity, 1996-Race and Ethnicity, 1996-

20002000

*Per 100,000, age-adjusted to the 2000 US standard population.† Hispanic is not mutually exclusive from whites, African Americans, Asian/Pacific Islanders, and American Indians.Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2003.

249.5

154.8172.3 176.7166.9

198.6

102.0115.8 112.4

356.2

0

50

100

150

200

250

300

350

400

White African American Asian/PacificIslander

American Indian/ Alaskan Native

Hispanic†

Men Women

•All sites 356.2All sites 356.2 249.5 1.4 249.5 1.4•LarynxLarynx 5.7 2.4 2.4 5.7 2.4 2.4•ProstateProstate 73.0 30.2 73.0 30.2 2.4 2.4•StomachStomach 14.0 14.0 6.1 6.1 2.3 2.3•MyelomaMyeloma 9.2 9.2 4.5 4.5 2.0 2.0 •Oral cavity and pharynx 7.9 4.0Oral cavity and pharynx 7.9 4.0 2.0 2.0•EsophagusEsophagus 12.2 12.2 7.3 7.3 1.7 1.7•LiverLiver 9.3 9.3 6.0 6.0 1.6 1.6•Lung & bronchus 107.0 78.1Lung & bronchus 107.0 78.1 1.4 1.4•PancreasPancreas 16.4 16.4 12.0 12.0 1.4 1.4•Small intestineSmall intestine 0.7 0.5 0.7 0.5 1.4 1.4•Colon & rectumColon & rectum 34.6 34.6 25.3 25.3 1.4 1.4

Cancer Sites in Which African-American Cancer Sites in Which African-American Death Rates Exceed White Death Rates for Death Rates Exceed White Death Rates for

Men, US, 1996-2000Men, US, 1996-2000

*Per 100,000, age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003.

Site African American

White Ratio of African

American/White

Cancer Survival*(%) by Site and Cancer Survival*(%) by Site and Race,1992-1999Race,1992-1999

*5-year relative survival rates based on cancer patients diagnosed from 1992 to 1999 and followed through 2000. Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003.

All Sites 64 53 11

Breast (female) 88 74 14

Colon & rectum 63 53 10

Esophagus 15 9 6

Leukemia 48 39 9

Non-Hodgkin lymphoma 57 47 10

Oral cavity 60 36 24

Prostate 99 93 6

Urinary bladder 83 64 19

Uterine cervix 73 61 12

Uterine corpus 86 60 26

Site White % DifferenceAfrican

American

Causes of Death in African Causes of Death in African Americans (2000) - GeorgiaAmericans (2000) - Georgia

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Cancer

Cardiovascular

Stroke

Diabetes

HIV/AIDS

Homicide

Unintentional Injury

Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Long Long Long Long Long Long Long Long Long

Bryan Bryan Bryan Bryan Bryan Bryan Bryan Bryan Bryan Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery

Candler Candler Candler Candler Candler Candler Candler Candler Candler

Tattnall Tattnall Tattnall Tattnall Tattnall Tattnall Tattnall Tattnall Tattnall

Johnson Johnson Johnson Johnson Johnson Johnson Johnson Johnson Johnson

Wilcox Wilcox Wilcox Wilcox Wilcox Wilcox Wilcox Wilcox Wilcox

Pulaski Pulaski Pulaski Pulaski Pulaski Pulaski Pulaski Pulaski Pulaski Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee

Schley Schley Schley Schley Schley Schley Schley Schley Schley

Marion Marion Marion Marion Marion Marion Marion Marion Marion

Morgan Morgan Morgan Morgan Morgan Morgan Morgan Morgan Morgan Greene Greene Greene Greene Greene Greene Greene Greene Greene

Richmond Richmond Richmond Richmond Richmond Richmond Richmond Richmond Richmond

Columbia Columbia Columbia Columbia Columbia Columbia Columbia Columbia Columbia McDuffie McDuffie McDuffie McDuffie McDuffie McDuffie McDuffie McDuffie McDuffie

Warren Warren Warren Warren Warren Warren Warren Warren Warren

Crawford Crawford Crawford Crawford Crawford Crawford Crawford Crawford Crawford Upson Upson Upson Upson Upson Upson Upson Upson Upson

Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oconee Oconee Oconee Oconee Oconee Oconee Oconee Oconee Oconee

Clarke Clarke Clarke Clarke Clarke Clarke Clarke Clarke Clarke

Clayton Clayton Clayton Clayton Clayton Clayton Clayton Clayton Clayton Fulton Fulton Fulton Fulton Fulton Fulton Fulton Fulton Fulton Douglas Douglas Douglas Douglas Douglas Douglas Douglas Douglas Douglas

DeKalb DeKalb DeKalb DeKalb DeKalb DeKalb DeKalb DeKalb DeKalb Cobb Cobb Cobb Cobb Cobb Cobb Cobb Cobb Cobb

Carroll Carroll Carroll Carroll Carroll Carroll Carroll Carroll Carroll

Paulding Paulding Paulding Paulding Paulding Paulding Paulding Paulding Paulding

Coffee Coffee Coffee Coffee Coffee Coffee Coffee Coffee Coffee

Charlton Charlton Charlton Charlton Charlton Charlton Charlton Charlton Charlton

Echols Echols Echols Echols Echols Echols Echols Echols Echols Lowndes Lowndes Lowndes Lowndes Lowndes Lowndes Lowndes Lowndes Lowndes

Clinch Clinch Clinch Clinch Clinch Clinch Clinch Clinch Clinch

Berrien Berrien Berrien Berrien Berrien Berrien Berrien Berrien Berrien

Seminole Seminole Seminole Seminole Seminole Seminole Seminole Seminole Seminole Decatur Decatur Decatur Decatur Decatur Decatur Decatur Decatur Decatur

Wayne Wayne Wayne Wayne Wayne Wayne Wayne Wayne Wayne

Ware Ware Ware Ware Ware Ware Ware Ware Ware

Worth Worth Worth Worth Worth Worth Worth Worth Worth Irwin Irwin Irwin Irwin Irwin Irwin Irwin Irwin Irwin

Mitchell Mitchell Mitchell Mitchell Mitchell Mitchell Mitchell Mitchell Mitchell Baker Baker Baker Baker Baker Baker Baker Baker Baker Early Early Early Early Early Early Early Early Early

Clay Clay Clay Clay Clay Clay Clay Clay Clay

Hall Hall Hall Hall Hall Hall Hall Hall Hall Forsyth Forsyth Forsyth Forsyth Forsyth Forsyth Forsyth Forsyth Forsyth

Dawson Dawson Dawson Dawson Dawson Dawson Dawson Dawson Dawson Floyd Floyd Floyd Floyd Floyd Floyd Floyd Floyd Floyd

Chattooga Chattooga Chattooga Chattooga Chattooga Chattooga Chattooga Chattooga Chattooga Walker Walker Walker Walker Walker Walker Walker Walker Walker

Habersham Habersham Habersham Habersham Habersham Habersham Habersham Habersham Habersham White White White White White White White White White

Rabun Rabun Rabun Rabun Rabun Rabun Rabun Rabun Rabun

Stephens Stephens Stephens Stephens Stephens Stephens Stephens Stephens Stephens

Towns Towns Towns Towns Towns Towns Towns Towns Towns Fannin Fannin Fannin Fannin Fannin Fannin Fannin Fannin Fannin Murray Murray Murray Murray Murray Murray Murray Murray Murray

Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield Catoosa Catoosa Catoosa Catoosa Catoosa Catoosa Catoosa Catoosa Catoosa Dade Dade Dade Dade Dade Dade Dade Dade Dade

Appling Appling Appling Appling Appling Appling Appling Appling Appling

Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson

Bacon Bacon Bacon Bacon Bacon Bacon Bacon Bacon Bacon

Baldwin Baldwin Baldwin Baldwin Baldwin Baldwin Baldwin Baldwin Baldwin

Banks Banks Banks Banks Banks Banks Banks Banks Banks

Barrow Barrow Barrow Barrow Barrow Barrow Barrow Barrow Barrow

Bartow Bartow Bartow Bartow Bartow Bartow Bartow Bartow Bartow

Bibb Bibb Bibb Bibb Bibb Bibb Bibb Bibb Bibb

Bleckley Bleckley Bleckley Bleckley Bleckley Bleckley Bleckley Bleckley Bleckley

Brantley Brantley Brantley Brantley Brantley Brantley Brantley Brantley Brantley

Brooks Brooks Brooks Brooks Brooks Brooks Brooks Brooks Brooks

Bulloch Bulloch Bulloch Bulloch Bulloch Bulloch Bulloch Bulloch Bulloch

Burke Burke Burke Burke Burke Burke Burke Burke Burke

Butts Butts Butts Butts Butts Butts Butts Butts Butts

Calhoun Calhoun Calhoun Calhoun Calhoun Calhoun Calhoun Calhoun Calhoun

Camden Camden Camden Camden Camden Camden Camden Camden Camden

Chatham Chatham Chatham Chatham Chatham Chatham Chatham Chatham Chatham

Cherokee Cherokee Cherokee Cherokee Cherokee Cherokee Cherokee Cherokee Cherokee

Colquitt Colquitt Colquitt Colquitt Colquitt Colquitt Colquitt Colquitt Colquitt Cook Cook Cook Cook Cook Cook Cook Cook Cook

Coweta Coweta Coweta Coweta Coweta Coweta Coweta Coweta Coweta

Crisp Crisp Crisp Crisp Crisp Crisp Crisp Crisp Crisp

Dodge Dodge Dodge Dodge Dodge Dodge Dodge Dodge Dodge Dooly Dooly Dooly Dooly Dooly Dooly Dooly Dooly Dooly

Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty

Effingham Effingham Effingham Effingham Effingham Effingham Effingham Effingham Effingham

Elbert Elbert Elbert Elbert Elbert Elbert Elbert Elbert Elbert

Emanuel Emanuel Emanuel Emanuel Emanuel Emanuel Emanuel Emanuel Emanuel

Evans Evans Evans Evans Evans Evans Evans Evans Evans

Fayette Fayette Fayette Fayette Fayette Fayette Fayette Fayette Fayette

Franklin Franklin Franklin Franklin Franklin Franklin Franklin Franklin Franklin

Gilmer Gilmer Gilmer Gilmer Gilmer Gilmer Gilmer Gilmer Gilmer

Glascock Glascock Glascock Glascock Glascock Glascock Glascock Glascock Glascock

Glynn Glynn Glynn Glynn Glynn Glynn Glynn Glynn Glynn

Gordon Gordon Gordon Gordon Gordon Gordon Gordon Gordon Gordon

Grady Grady Grady Grady Grady Grady Grady Grady Grady

Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett

Hancock Hancock Hancock Hancock Hancock Hancock Hancock Hancock Hancock

Haralson Haralson Haralson Haralson Haralson Haralson Haralson Haralson Haralson

Harris Harris Harris Harris Harris Harris Harris Harris Harris

Hart Hart Hart Hart Hart Hart Hart Hart Hart

Heard Heard Heard Heard Heard Heard Heard Heard Heard

Henry Henry Henry Henry Henry Henry Henry Henry Henry

Houston Houston Houston Houston Houston Houston Houston Houston Houston

Jackson Jackson Jackson Jackson Jackson Jackson Jackson Jackson Jackson

Jasper Jasper Jasper Jasper Jasper Jasper Jasper Jasper Jasper

Jefferson Jefferson Jefferson Jefferson Jefferson Jefferson Jefferson Jefferson Jefferson

Jenkins Jenkins Jenkins Jenkins Jenkins Jenkins Jenkins Jenkins Jenkins

Jones Jones Jones Jones Jones Jones Jones Jones Jones Lamar Lamar Lamar Lamar Lamar Lamar Lamar Lamar Lamar

Lanier Lanier Lanier Lanier Lanier Lanier Lanier Lanier Lanier

Laurens Laurens Laurens Laurens Laurens Laurens Laurens Laurens Laurens

Lee Lee Lee Lee Lee Lee Lee Lee Lee Liberty Liberty Liberty Liberty Liberty Liberty Liberty Liberty Liberty

Lincoln Lincoln Lincoln Lincoln Lincoln Lincoln Lincoln Lincoln Lincoln

Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin

McIntosh McIntosh McIntosh McIntosh McIntosh McIntosh McIntosh McIntosh McIntosh

Macon Macon Macon Macon Macon Macon Macon Macon Macon

Madison Madison Madison Madison Madison Madison Madison Madison Madison

Meriwether Meriwether Meriwether Meriwether Meriwether Meriwether Meriwether Meriwether Meriwether

Miller Miller Miller Miller Miller Miller Miller Miller Miller

Monroe Monroe Monroe Monroe Monroe Monroe Monroe Monroe Monroe

Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee

Newton Newton Newton Newton Newton Newton Newton Newton Newton

Peach Peach Peach Peach Peach Peach Peach Peach Peach

Pickens Pickens Pickens Pickens Pickens Pickens Pickens Pickens Pickens

Pierce Pierce Pierce Pierce Pierce Pierce Pierce Pierce Pierce

Pike Pike Pike Pike Pike Pike Pike Pike Pike

Polk Polk Polk Polk Polk Polk Polk Polk Polk

Putnam Putnam Putnam Putnam Putnam Putnam Putnam Putnam Putnam

Quitman Quitman Quitman Quitman Quitman Quitman Quitman Quitman Quitman Randolph Randolph Randolph Randolph Randolph Randolph Randolph Randolph Randolph

Rockdale Rockdale Rockdale Rockdale Rockdale Rockdale Rockdale Rockdale Rockdale

Screven Screven Screven Screven Screven Screven Screven Screven Screven

Spalding Spalding Spalding Spalding Spalding Spalding Spalding Spalding Spalding

Stewart Stewart Stewart Stewart Stewart Stewart Stewart Stewart Stewart Sumter Sumter Sumter Sumter Sumter Sumter Sumter Sumter Sumter

Talbot Talbot Talbot Talbot Talbot Talbot Talbot Talbot Talbot

Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro

Taylor Taylor Taylor Taylor Taylor Taylor Taylor Taylor Taylor

Telfair Telfair Telfair Telfair Telfair Telfair Telfair Telfair Telfair Terrell Terrell Terrell Terrell Terrell Terrell Terrell Terrell Terrell

Thomas Thomas Thomas Thomas Thomas Thomas Thomas Thomas Thomas

Tift Tift Tift Tift Tift Tift Tift Tift Tift

Toombs Toombs Toombs Toombs Toombs Toombs Toombs Toombs Toombs

Treutlen Treutlen Treutlen Treutlen Treutlen Treutlen Treutlen Treutlen Treutlen

Troup Troup Troup Troup Troup Troup Troup Troup Troup

Turner Turner Turner Turner Turner Turner Turner Turner Turner

Twiggs Twiggs Twiggs Twiggs Twiggs Twiggs Twiggs Twiggs Twiggs

Union Union Union Union Union Union Union Union Union

Walton Walton Walton Walton Walton Walton Walton Walton Walton

Washington Washington Washington Washington Washington Washington Washington Washington Washington

Webster Webster Webster Webster Webster Webster Webster Webster Webster Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler

Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes

Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson

1999

Data Source: Inforum, 2000 Prepared by: G.E. Alan Dever, Ph.D., M.T., M.D. (Hon.), Leah Trawick, B.S., & Lucy Kemp

Health Status Health Status Health Status Health Status Health Status Health Status Health Status Health Status Health Status Excellent 67-100 Good 40-66 Fair 26-39 Poor 0-25

Department of Community Medicine - Mercer University School of Medicine

Georgia Health Status Score: 51.9

Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Ben Hill Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Jeff Davis Long Long Long Long Long Long Long Long Long

Bryan Bryan Bryan Bryan Bryan Bryan Bryan Bryan Bryan Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery Montgomery

Candler Candler Candler Candler Candler Candler Candler Candler Candler

Tattnall Tattnall Tattnall Tattnall Tattnall Tattnall Tattnall Tattnall Tattnall

Johnson Johnson Johnson Johnson Johnson Johnson Johnson Johnson Johnson

Wilcox Wilcox Wilcox Wilcox Wilcox Wilcox Wilcox Wilcox Wilcox

Pulaski Pulaski Pulaski Pulaski Pulaski Pulaski Pulaski Pulaski Pulaski Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee Chattahoochee

Schley Schley Schley Schley Schley Schley Schley Schley Schley

Marion Marion Marion Marion Marion Marion Marion Marion Marion

Morgan Morgan Morgan Morgan Morgan Morgan Morgan Morgan Morgan Greene Greene Greene Greene Greene Greene Greene Greene Greene

Richmond Richmond Richmond Richmond Richmond Richmond Richmond Richmond Richmond

Columbia Columbia Columbia Columbia Columbia Columbia Columbia Columbia Columbia McDuffie McDuffie McDuffie McDuffie McDuffie McDuffie McDuffie McDuffie McDuffie

Warren Warren Warren Warren Warren Warren Warren Warren Warren

Crawford Crawford Crawford Crawford Crawford Crawford Crawford Crawford Crawford Upson Upson Upson Upson Upson Upson Upson Upson Upson

Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oglethorpe Oconee Oconee Oconee Oconee Oconee Oconee Oconee Oconee Oconee

Clarke Clarke Clarke Clarke Clarke Clarke Clarke Clarke Clarke

Clayton Clayton Clayton Clayton Clayton Clayton Clayton Clayton Clayton Fulton Fulton Fulton Fulton Fulton Fulton Fulton Fulton Fulton Douglas Douglas Douglas Douglas Douglas Douglas Douglas Douglas Douglas

DeKalb DeKalb DeKalb DeKalb DeKalb DeKalb DeKalb DeKalb DeKalb Cobb Cobb Cobb Cobb Cobb Cobb Cobb Cobb Cobb

Carroll Carroll Carroll Carroll Carroll Carroll Carroll Carroll Carroll

Paulding Paulding Paulding Paulding Paulding Paulding Paulding Paulding Paulding

Coffee Coffee Coffee Coffee Coffee Coffee Coffee Coffee Coffee

Charlton Charlton Charlton Charlton Charlton Charlton Charlton Charlton Charlton

Echols Echols Echols Echols Echols Echols Echols Echols Echols Lowndes Lowndes Lowndes Lowndes Lowndes Lowndes Lowndes Lowndes Lowndes

Clinch Clinch Clinch Clinch Clinch Clinch Clinch Clinch Clinch

Berrien Berrien Berrien Berrien Berrien Berrien Berrien Berrien Berrien

Seminole Seminole Seminole Seminole Seminole Seminole Seminole Seminole Seminole Decatur Decatur Decatur Decatur Decatur Decatur Decatur Decatur Decatur

Wayne Wayne Wayne Wayne Wayne Wayne Wayne Wayne Wayne

Ware Ware Ware Ware Ware Ware Ware Ware Ware

Worth Worth Worth Worth Worth Worth Worth Worth Worth Irwin Irwin Irwin Irwin Irwin Irwin Irwin Irwin Irwin

Mitchell Mitchell Mitchell Mitchell Mitchell Mitchell Mitchell Mitchell Mitchell Baker Baker Baker Baker Baker Baker Baker Baker Baker Early Early Early Early Early Early Early Early Early

Clay Clay Clay Clay Clay Clay Clay Clay Clay

Hall Hall Hall Hall Hall Hall Hall Hall Hall Forsyth Forsyth Forsyth Forsyth Forsyth Forsyth Forsyth Forsyth Forsyth

Dawson Dawson Dawson Dawson Dawson Dawson Dawson Dawson Dawson Floyd Floyd Floyd Floyd Floyd Floyd Floyd Floyd Floyd

Chattooga Chattooga Chattooga Chattooga Chattooga Chattooga Chattooga Chattooga Chattooga Walker Walker Walker Walker Walker Walker Walker Walker Walker

Habersham Habersham Habersham Habersham Habersham Habersham Habersham Habersham Habersham White White White White White White White White White

Rabun Rabun Rabun Rabun Rabun Rabun Rabun Rabun Rabun

Stephens Stephens Stephens Stephens Stephens Stephens Stephens Stephens Stephens

Towns Towns Towns Towns Towns Towns Towns Towns Towns Fannin Fannin Fannin Fannin Fannin Fannin Fannin Fannin Fannin Murray Murray Murray Murray Murray Murray Murray Murray Murray

Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield Whitfield Catoosa Catoosa Catoosa Catoosa Catoosa Catoosa Catoosa Catoosa Catoosa Dade Dade Dade Dade Dade Dade Dade Dade Dade

Appling Appling Appling Appling Appling Appling Appling Appling Appling

Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson Atkinson

Bacon Bacon Bacon Bacon Bacon Bacon Bacon Bacon Bacon

Baldwin Baldwin Baldwin Baldwin Baldwin Baldwin Baldwin Baldwin Baldwin

Banks Banks Banks Banks Banks Banks Banks Banks Banks

Barrow Barrow Barrow Barrow Barrow Barrow Barrow Barrow Barrow

Bartow Bartow Bartow Bartow Bartow Bartow Bartow Bartow Bartow

Bibb Bibb Bibb Bibb Bibb Bibb Bibb Bibb Bibb

Bleckley Bleckley Bleckley Bleckley Bleckley Bleckley Bleckley Bleckley Bleckley

Brantley Brantley Brantley Brantley Brantley Brantley Brantley Brantley Brantley

Brooks Brooks Brooks Brooks Brooks Brooks Brooks Brooks Brooks

Bulloch Bulloch Bulloch Bulloch Bulloch Bulloch Bulloch Bulloch Bulloch

Burke Burke Burke Burke Burke Burke Burke Burke Burke

Butts Butts Butts Butts Butts Butts Butts Butts Butts

Calhoun Calhoun Calhoun Calhoun Calhoun Calhoun Calhoun Calhoun Calhoun

Camden Camden Camden Camden Camden Camden Camden Camden Camden

Chatham Chatham Chatham Chatham Chatham Chatham Chatham Chatham Chatham

Cherokee Cherokee Cherokee Cherokee Cherokee Cherokee Cherokee Cherokee Cherokee

Colquitt Colquitt Colquitt Colquitt Colquitt Colquitt Colquitt Colquitt Colquitt Cook Cook Cook Cook Cook Cook Cook Cook Cook

Coweta Coweta Coweta Coweta Coweta Coweta Coweta Coweta Coweta

Crisp Crisp Crisp Crisp Crisp Crisp Crisp Crisp Crisp

Dodge Dodge Dodge Dodge Dodge Dodge Dodge Dodge Dodge Dooly Dooly Dooly Dooly Dooly Dooly Dooly Dooly Dooly

Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty Dougherty

Effingham Effingham Effingham Effingham Effingham Effingham Effingham Effingham Effingham

Elbert Elbert Elbert Elbert Elbert Elbert Elbert Elbert Elbert

Emanuel Emanuel Emanuel Emanuel Emanuel Emanuel Emanuel Emanuel Emanuel

Evans Evans Evans Evans Evans Evans Evans Evans Evans

Fayette Fayette Fayette Fayette Fayette Fayette Fayette Fayette Fayette

Franklin Franklin Franklin Franklin Franklin Franklin Franklin Franklin Franklin

Gilmer Gilmer Gilmer Gilmer Gilmer Gilmer Gilmer Gilmer Gilmer

Glascock Glascock Glascock Glascock Glascock Glascock Glascock Glascock Glascock

Glynn Glynn Glynn Glynn Glynn Glynn Glynn Glynn Glynn

Gordon Gordon Gordon Gordon Gordon Gordon Gordon Gordon Gordon

Grady Grady Grady Grady Grady Grady Grady Grady Grady

Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett Gwinnett

Hancock Hancock Hancock Hancock Hancock Hancock Hancock Hancock Hancock

Haralson Haralson Haralson Haralson Haralson Haralson Haralson Haralson Haralson

Harris Harris Harris Harris Harris Harris Harris Harris Harris

Hart Hart Hart Hart Hart Hart Hart Hart Hart

Heard Heard Heard Heard Heard Heard Heard Heard Heard

Henry Henry Henry Henry Henry Henry Henry Henry Henry

Houston Houston Houston Houston Houston Houston Houston Houston Houston

Jackson Jackson Jackson Jackson Jackson Jackson Jackson Jackson Jackson

Jasper Jasper Jasper Jasper Jasper Jasper Jasper Jasper Jasper

Jefferson Jefferson Jefferson Jefferson Jefferson Jefferson Jefferson Jefferson Jefferson

Jenkins Jenkins Jenkins Jenkins Jenkins Jenkins Jenkins Jenkins Jenkins

Jones Jones Jones Jones Jones Jones Jones Jones Jones Lamar Lamar Lamar Lamar Lamar Lamar Lamar Lamar Lamar

Lanier Lanier Lanier Lanier Lanier Lanier Lanier Lanier Lanier

Laurens Laurens Laurens Laurens Laurens Laurens Laurens Laurens Laurens

Lee Lee Lee Lee Lee Lee Lee Lee Lee Liberty Liberty Liberty Liberty Liberty Liberty Liberty Liberty Liberty

Lincoln Lincoln Lincoln Lincoln Lincoln Lincoln Lincoln Lincoln Lincoln

Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin Lumpkin

McIntosh McIntosh McIntosh McIntosh McIntosh McIntosh McIntosh McIntosh McIntosh

Macon Macon Macon Macon Macon Macon Macon Macon Macon

Madison Madison Madison Madison Madison Madison Madison Madison Madison

Meriwether Meriwether Meriwether Meriwether Meriwether Meriwether Meriwether Meriwether Meriwether

Miller Miller Miller Miller Miller Miller Miller Miller Miller

Monroe Monroe Monroe Monroe Monroe Monroe Monroe Monroe Monroe

Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee Muscogee

Newton Newton Newton Newton Newton Newton Newton Newton Newton

Peach Peach Peach Peach Peach Peach Peach Peach Peach

Pickens Pickens Pickens Pickens Pickens Pickens Pickens Pickens Pickens

Pierce Pierce Pierce Pierce Pierce Pierce Pierce Pierce Pierce

Pike Pike Pike Pike Pike Pike Pike Pike Pike

Polk Polk Polk Polk Polk Polk Polk Polk Polk

Putnam Putnam Putnam Putnam Putnam Putnam Putnam Putnam Putnam

Quitman Quitman Quitman Quitman Quitman Quitman Quitman Quitman Quitman Randolph Randolph Randolph Randolph Randolph Randolph Randolph Randolph Randolph

Rockdale Rockdale Rockdale Rockdale Rockdale Rockdale Rockdale Rockdale Rockdale

Screven Screven Screven Screven Screven Screven Screven Screven Screven

Spalding Spalding Spalding Spalding Spalding Spalding Spalding Spalding Spalding

Stewart Stewart Stewart Stewart Stewart Stewart Stewart Stewart Stewart Sumter Sumter Sumter Sumter Sumter Sumter Sumter Sumter Sumter

Talbot Talbot Talbot Talbot Talbot Talbot Talbot Talbot Talbot

Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro Taliaferro

Taylor Taylor Taylor Taylor Taylor Taylor Taylor Taylor Taylor

Telfair Telfair Telfair Telfair Telfair Telfair Telfair Telfair Telfair Terrell Terrell Terrell Terrell Terrell Terrell Terrell Terrell Terrell

Thomas Thomas Thomas Thomas Thomas Thomas Thomas Thomas Thomas

Tift Tift Tift Tift Tift Tift Tift Tift Tift

Toombs Toombs Toombs Toombs Toombs Toombs Toombs Toombs Toombs

Treutlen Treutlen Treutlen Treutlen Treutlen Treutlen Treutlen Treutlen Treutlen

Troup Troup Troup Troup Troup Troup Troup Troup Troup

Turner Turner Turner Turner Turner Turner Turner Turner Turner

Twiggs Twiggs Twiggs Twiggs Twiggs Twiggs Twiggs Twiggs Twiggs

Union Union Union Union Union Union Union Union Union

Walton Walton Walton Walton Walton Walton Walton Walton Walton

Washington Washington Washington Washington Washington Washington Washington Washington Washington

Webster Webster Webster Webster Webster Webster Webster Webster Webster Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler Wheeler

Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes Wilkes

Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson Wilkinson

2001

Data Source: Inforum, 2002 Prepared by: G.E. Alan Dever, Ph.D., M.T., M.D. (Hon.) & Leah Smith, M.P.H.

Health Status Health Status Health Status Health Status Health Status Health Status Health Status Health Status

Department of Community Medicine - Mercer University School of Medicine

Excellent 58-100 Health Status

Good 33-57 Fair 21-32 Poor 0-20

Georgia Health Status Score: 37.8

Health Status in Georgia

Disparities in GeorgiaDisparities in Georgia

Outcomes in GeorgiaOutcomes in Georgia Infant mortality rates in African Americans Infant mortality rates in African Americans

is more than twice that in Whites.is more than twice that in Whites. Prostate Cancer death rates are > 50% Prostate Cancer death rates are > 50%

higher in African Americans.higher in African Americans. African Americans are more than twice as African Americans are more than twice as

likely to die from Hypertensive Heart likely to die from Hypertensive Heart Disease.Disease.

Hispanics are twice as likely to die from Hispanics are twice as likely to die from Diabetes than whites.Diabetes than whites.From: Georgia Division of Public Health; Vital Statistics 2001

Disparities in GeorgiaDisparities in Georgia

Coverage in GeorgiaCoverage in Georgia More likely to use emergency room as More likely to use emergency room as

main source of medical care.main source of medical care. 4 to 5 times less likely to have had BP 4 to 5 times less likely to have had BP

check in last 2yrs.check in last 2yrs. 3 to 4 times less likely to have had a 3 to 4 times less likely to have had a

mammogram in last 2yrs.mammogram in last 2yrs. Children 2 times less likely to have seen Children 2 times less likely to have seen

a doctor in last 2 years.a doctor in last 2 years.

Uninsured by Ethnicity Uninsured by Ethnicity (2002) - GA.(2002) - GA.

WhiteAfrican AmericanHispanicOther

11%6.8%

20.3% 13.8%

From : Georgia Healthcare Coverage Project ( Custer & Ketsche 2003)

Uninsured by Ethnicity Uninsured by Ethnicity (2002) - USA(2002) - USA

White

African American

Hispanic

Asian

18.2%%10.7%

20.2%

32.4%

Uninsured by race and Uninsured by race and incomeincome

0 10 20 30 40

White

African-American

Hispanic

Other

>300%FPL<300%FPL<200%FPL<FPL

From : Georgia Healthcare Coverage Project ( Custer & Ketsche 2003)

I.O.M ReportI.O.M Report

“In unassailable terms, the report found that even when their insurance and income are the same as those of whites, minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments, including heart disease, cancer, diabetes and HIV/AIDS. By stripping away the pretense that the differences can be explained by minorities' lack of access to timely care, the report should spur doctors and patients to question why racial disparities are tolerated in medicine.”

USA Today, March 22 “Racial Bias in Health Care”

I.O.M. RecommendationsI.O.M. Recommendations

Policy & RegulatoryPolicy & Regulatory Avoid fragmentation of health plans Avoid fragmentation of health plans

along socioeconomic lines.along socioeconomic lines. Strengthen the stability of patient-Strengthen the stability of patient-

provider relationships in publicly provider relationships in publicly funded health plans.funded health plans.

Increase the proportion of under-Increase the proportion of under-represented US racial and ethnic represented US racial and ethnic minorities among health professionals.minorities among health professionals.

From : Unequal Treatment; Confronting Racial and Ethnic Disparities in Health care – IOM 2003

I.O.M. RecommendationsI.O.M. Recommendations

Policy & RegulatoryPolicy & Regulatory Apply the same managed care Apply the same managed care

protections to publicly funded HMO protections to publicly funded HMO enrollees that apply to private HMO enrollees that apply to private HMO enrollees.enrollees.

Provide greater resources for the DHHS Provide greater resources for the DHHS Office for Civil Rights to enforce civil Office for Civil Rights to enforce civil rights laws.rights laws.

From : Unequal treatment; Confronting Racial and Ethnic Disparities in Health care – IOM 2003

I.O.M. RecommendationsI.O.M. Recommendations

Health SystemsHealth Systems Promote the consistency and equity of care Promote the consistency and equity of care

through use of evidence based guidelines.through use of evidence based guidelines. Structure payment systems to ensure Structure payment systems to ensure

adequate supply of services to minority adequate supply of services to minority patients and limit provider incentives that patients and limit provider incentives that promote disparities.promote disparities.

Enhance patient-provider communications Enhance patient-provider communications and trust by providing financial incentives and trust by providing financial incentives for practices that decrease barriers and for practices that decrease barriers and encourage evidence based practices. encourage evidence based practices.

From : Unequal treatment; Confronting Racial and Ethnic Disparities in Health care – IOM 2003

I.O.M. RecommendationsI.O.M. Recommendations

Health SystemHealth System Support the use of interpretation Support the use of interpretation

services where community need exists.services where community need exists. Support the use of community health Support the use of community health

workersworkers Implement multi-disciplinary treatment Implement multi-disciplinary treatment

and preventive care teams.and preventive care teams.

From : Unequal treatment; Confronting Racial and Ethnic Disparities in Health care – IOM 2003

I.O.M. RecommendationsI.O.M. Recommendations

EducationEducation Implement patient education programs Implement patient education programs

to increase patient’s knowledge of how to increase patient’s knowledge of how to best access care and participate in to best access care and participate in treatment decisions.treatment decisions.

Integrate cross cultural education into Integrate cross cultural education into the training of all current and future the training of all current and future health professionals.health professionals.

From : Unequal treatment; Confronting Racial and Ethnic Disparities in Health care – IOM 2003

Federal ActionFederal Action

DHHS Initiative to Eliminate Racial and DHHS Initiative to Eliminate Racial and Ethnic Disparities in HealthEthnic Disparities in Health

NIH Strategic Research Plan to Reduce NIH Strategic Research Plan to Reduce and Ultimately Eliminate Health and Ultimately Eliminate Health DisparitiesDisparities

NLM Strategic Plan to Reduce Racial NLM Strategic Plan to Reduce Racial and Ethnic Disparitiesand Ethnic Disparities

Healthy People 2010Healthy People 2010 100% access, Zero Disparities - BPHC 100% access, Zero Disparities - BPHC

Community ActionCommunity Action

Hispanic Health Care OutreachHispanic Health Care Outreach North West Georgia Healthcare North West Georgia Healthcare

Partnership VisionPartnership Vision ““Promotora” – Community health workerPromotora” – Community health worker Improved accessImproved access

Focus on Men's HealthFocus on Men's Health Network of South-central countiesNetwork of South-central counties Screening ( PSA, Cholesterol and BP)Screening ( PSA, Cholesterol and BP) Early detectionEarly detection

Knowledge is KeyKnowledge is Key

Action is Power