UNC 7th Annual Summer Public Health Research InstituteUNC 7th Annual Summer Public Health Research Instituteon Minority Healthon Minority Health

William D. Hobson, MSWilliam D. Hobson, MSDeputy Associate Administrator,Deputy Associate Administrator,Bureau of Primary Health CareBureau of Primary Health Care

Current Needs and Current Issues in Current Needs and Current Issues in Minority Health ResearchMinority Health Research

The People We Are…The People We ServeThe People We Are…The People We Serve

Chapel Hill, NCChapel Hill, NC June 18, 2001 June 18, 2001

Need for Minority Health ResearchNeed for Minority Health Research

Increasing growth rate of racial/ethnic minoritiesin the U.S. population

Poorer health status of some racial/ethnic minority populations

Increasing percentage of racial/ethnic minoritiesof the U.S. population

Poorer health care outcomes of some racial/ethnic minorities

Some of the factors contributing to the poor health statusand poor health care outcomes of racial/ethnic minorities are not well understood

General Indicators of General Indicators of Disparate Health StatusDisparate Health Status

Higher rates of morbidity and mortality forAfrican Americans

Native Americans and Hispanics have worse health outcomes than the total population

Some Asian/Pacific Islander subgroups havevery poor health status outcomes

Health DisparitiesHealth Disparities

A Key Indicator of the Need for Research in Minority Health

HRSA/BPHC Working DefinitionHRSA/BPHC Working Definition of a Health Disparity of a Health Disparity

A population-specific difference in the presence of disease, health outcomes,

or access to care.

Bases of Health DisparitiesBases of Health Disparities

Differences in Economic Condition

Differences in Education

Differences in Other Social Conditions

Differences in Environment (Work/Neighborhood/Home)

Genetic Differences

Emerging Research TopicsEmerging Research Topics Requiring Further Study Requiring Further Study

The Provision of Less Optimal Care

Racial & Ethnic Variations in Response to Medical Treatment

Historic Concept of Race in Health Care Historic Concept of Race in Health Care Research Is Based on Several Flawed Research Is Based on Several Flawed

Genetic AssumptionsGenetic Assumptions

That race is a valid biologic category

That genes determining race are linked to those determining health

That the health of a population is largely determined by the biologic composition of the population

Alternative MultidimensionalAlternative Multidimensional Concept of Race Is Based on Concept of Race Is Based on

A Socially Constructed TaxonomyA Socially Constructed Taxonomy

That reflects cultural determinants

That reflects socioeconomic determinants

That reflects Legal determinants

That reflects political determinants

That reflects biologic determinants

Intermediary Factors & ProcessesIntermediary Factors & ProcessesEffecting Health of MinoritiesEffecting Health of Minorities

Health Practices

Psychosocial stresses

Environmental Stresses

Psychosocial resources

Access to medical care

Assumptions Regarding the Statistical Assumptions Regarding the Statistical Validity of Racial/Ethnic DataValidity of Racial/Ethnic Data

That racial and ethnic categories and group designations are both consistently defined and consistently ascertained

That the categories and designations are understood by the populations questioned

That the survey enumeration, participation, and response rates are high and similar for all populations

That the responses of persons are consistent in different data sources and at different times

Minority Health IssuesMinority Health Issues

Economic

Geographic

Cultural

Linguistic

Social

Issues of Access

Minority Health Issues (cont.)Minority Health Issues (cont.)

Infant mortality

Low-weight births

Chronic disease incidence rates

Communicable disease incidence rates

Issues of Health status

Minority Health Issues (cont.)Minority Health Issues (cont.)

Evidence-based medicine Cultural competence Awareness of the patient’s environment (home & work) Disparities in treatment (provision of less-optimal care) Disparities in patient care outcomes Differential response to pharmaceuticals Racial and ethnic variations in response to treatment Improving patient education Changing clinician behavior

Issues of Patient Care Quality

Minority Health Issues (cont.)Minority Health Issues (cont.)

Predisposition associated with race/ethnicity

Protective factors associated with race/ethnicity

Issues of Genetics

Minority Health Issues (cont.)Minority Health Issues (cont.)

Analysis of traditional approaches (What works; what doesn’t?)

Analysis of current innovations

Design and testing of new approaches

Issues of Prevention

Minority Health Issues (cont.)Minority Health Issues (cont.)

Analysis of traditional approaches (What works; what doesn’t?)

Analysis of current innovations

Design and testing of new approaches

Issues of Health/Human Services Integration

Minority Health Issues (cont.)Minority Health Issues (cont.)

Effect of various market pressures on services to minorities

Effects of changes in the health care marketplace on minorities

Benefits & shortcomings of health insurance on health care access and health status

Health care financing for the poor and underserved

Safety net providers

Issues of Health Care Policy

Issues of Cultural Competence Assessment of the association between cultural

competence and improvement in health outcomes

Cost benefit analysis of culturally competent servicesin ambulatory health care settings

Evaluation of the effectiveness of cultural competence curricula in health professions school

Assessment of community-based education as a tool to teach cultural competence

Does provider-patient racial or ethnic concordance improve patient satisfaction?

Minority Health Issues (cont.)Minority Health Issues (cont.)

Minority Health Research Challenges

Some members of racial and ethnic minority groups shun participation in research studies because of historical mistrust due to past experiences with racism, bias or exploitation in health care delivery and past health research.

Some racial and ethnic minorities feel that their groups have not benefited from their participation in past research.

Differing values and social, cultural, religious and spiritual beliefs related to health may inhibit certain groups from participating in research protocols or studies.

Minority Health Research Challenges (cont.)

Members of diverse racial and ethnic groups that are fairly new to this country may neither be accustomed nor willing to participate in research conducted according to traditional U.S. methodologies.

Many faculty within institutions of higher education neither use nor teach research methodologies that are culturally competent and use participatory action.

Funders of research have been slow to require principles of cultural competence, participatory action research designs and advocacy-oriented approaches in grants and contracts they support.

There is a need for research to validate the efficacy of culturally and linguistically competent approaches to health care delivery.

In summary there is no shortage of need for minority health research and

certainly no shortage of research issuesthat are pertinent to and vital for racial and

ethnic minority populations and researchers.

The People We Are…The People We ServeThe People We Are…The People We Serve