Cultural Diversity ELDER Project Fairfield University School of Nursing Session 5 – Healthcare Disparities Supported by DHHS/HRSA/BHPR/Division of Nursing

Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

Cultural Diversity

ELDER ProjectFairfield University School of Nursing

Session 5 – Healthcare Disparities


Healthcare DisparitiesObjectives: Upon completion of this session,

the participants will be able to ….Define ethnocentrism and the implications

cultural differences have on healthcare.Identify factors that contribute to health

disparities.Examine the demographics of these disparities in

the local and state area.Identify cultural competence as an effective

strategy to address health disparities.


Healthcare DisparitiesIntroduction:

Every culture defines :what health is for its membersdetermines etiology of diseases establishes parameters within which distress is defined signals and prescribes the appropriate means to treat the

disorder.

Understanding a person’s culture is fundamental to providing medical care.Contrasting values may result in conflicting expectations of involving others in providing care.


Healthcare DisparitiesEthnocentrism:

The belief or attitude that one’s own cultural view is the only correct view. It can cause healthcare providers to misinterpret cross-cultural situations, which can:

lead to miscommunication, stereotypes and disrespect

cause a breakdown in the delivery of culturally

competent care


Healthcare DisparitiesRacial/Ethnic Composition of Fairfield County,

Connecticut:Source: Fairfield County Quick Facts from the US Census Bureau That of minority racial/ethnic groups will influence the future health of the U.S.

substantially. Differences in treatment contribute to higher death rates for minorities.Group Percentage of

Population

White 83%

White/Non-Hispanic 68.5%

Hispanic/Latino 16%

Black/African American 11%

Asian 4.5%

American Indian 0.3%

Pacific Islander 0.1%


Healthcare DisparitiesHealth Disparities:

Those avoidable differences in health among specific population groups that result from cumulative social disadvantages.

Population groups experience: reduced healthcare quality and accessincreased rates of diseasedisability death


Healthcare DisparitiesFactors that Affect Health Status and Access to

Healthcare:Socioeconomic positionIncomeHousingEducation:

Education and income are both independently linked to health

Death rates from chronic disease, communicable diseases and injuries are inversely related to education.

Education is a benchmark for building literacy skill. Limited education causes a large percentage of adults in the US to have great difficulty successfully performing health-related literacy activities.


Healthcare DisparitiesFactors that Affect Health Status and Access to

Healthcare (continued): Employment Health barriers Individual biological susceptibility Early childhood and familial influences Access to power/ decision-making/ supportive resources Racial and ethnic minority Americans are less likely to possess

health insurance. Lack of heath insurance coverage has been identified as the

single most important factor in explaining differences between health status of African Americans, Hispanics and Whites.

Minority population groups who are poor, lack resources and have less than a high school education are likely to have limited literacy skills.


Healthcare DisparitiesHealth Literacy:The degree to which individuals have the capacity to

obtain, process and understand basic health information and services needed to make appropriate health decisions.

Healthy People 2010:People with low health literacy are: less likely to report poor health, less likely to have a complete understanding of their

health problems and treatments,at greater risk of hospitalization.


Facts About Health DisparitiesBlacks or African Americans suffer:

worse health outcomes than any other race.more from major chronic diseases than whites

in the following disease categories:Heart disease………………………………20% higherCancer…………………………………………20% higherStroke/cardiovascular disease…….30% higherDiabetes………………………………………3 times higherHIV/AIDS…………………………………...16% higherUnintentional injuries………………..40% higher


Facts About Health DisparitiesHispanics or Latinos are the fastest growing

population in the nation and the largest ethnic group in Connecticut.

American Indians and Alaska Natives suffer extraordinarily high rates of the following diseases:

TB………………………………………..600% higher Alcoholism …………………………..510% higher

Motor Vehicle Crashes…………229% higherDiabetes ………………………………189% higherUnintentional injuries…………..152% higher


Healthcare DisparitiesTarget Areas for the Elimination of Health Disparities by the

US Department of Health and Human Services: Cancer Cardiovascular Disease Infant Mortality Diabetes HIV/AIDS Child and Adult Immunizations

The Connecticut Department of Public Health has added the following to their Surveillance: Asthma Obesity Oral Health Infectious Diseases and Sexually Transmitted Diseases Environmental Health


Target Areas from the US Department of Health and

Human Services (HHS)

Descriptor from the Connecticut Health Disparities

Project (HDP),CT DPH Fall 2007

Cancer Significant racial differences in appropriate diagnostic testing and treatment.

Cardiovascular Disease Minorities are less likely to be given appropriate cardiac medications or to undergo bypass surgery. African Americans suffer strokes at a 35% higher rate than whites and are less likely to receive major diagnostic and therapeutic interventions.


Target Areas from the US Department of Health and Human Services

(HHS)

Descriptor from the Connecticut Health Disparities Project

(HDP),CT DPH Fall 2007

Infant Mortality Minority women are less likely to undergo Cesarean sections.Children are less likely to get prescription medications.In Connecticut, women in these groups have the highest percentage of late or no prenatal care in the first trimester and the highest rate of low birth weight infants.

Diabetes Minorities have higher death rate and illness from diabetes.African Americans are less likely to get key diagnostic tests.Minorities are more likely to get less desirable procedures, i.e. lower leg amputations.


Target Areas from the US Department of Health and

Human Services (HHS)

Descriptor from the Connecticut Health

Disparities Project (HDP),CT DPH Fall 2007

HIV/AIDS Minorities are less likely to receive antiretroviral therapy and other state-of-the-art treatment.In Connecticut, it is more prevalent in Hispanics and Blacks.

Child and Adult Immunizations The following groups receive influenza vaccine:48% of African Americans56% of Hispanics67% of Whites The following groups receive the pneumococcal vaccine:31% African Americans30% Hispanics57% Whites


ConnecticutAsthma African Americans are less

likely to receive appropriate medications to manage chronic symptoms. Highest incident is seen in Hispanic and Black children.

Obesity Seen more in lower income groups (less than 25,000/year). Linked to hypertension, high cholesterol and triglyceride levels, diabetes, heart disease and cancer.


ConnecticutOral Health The incidence of tooth decay in

kindergarteners and third graders includes:49.3% Hispanics43% African Americans42% Asians28.9% Whites

Infectious Diseases and STDs The highest incidence of TB is among Asian residents. STDs (Chlamydia, gonorrhea, syphilis) are more prevalent in the African American community.


ConnecticutEnvironmental Health Hispanics have 2.4 times more

non-fatal work related injuries and illnesses than whites. Blacks and Hispanic residents of all ages have the highest asthma hospital rates (332 per 100,000 populations) than whites (84.5 per 100,000 populations). Native American children have three times higher lead blood levels than whites.Blacks have 2.7 times higher levels than whites.


Healthcare DisparitiesConclusion:

Cultural competence is a strategy to improve quality and address disparities. The goal is to provide the highest quality care to every patient regardless of race, ethnicity and culture or language proficiency.


Reference CT Department of Public Health. (2009). Facts About Health Disparities in Connecticut, 2009.

Retrieved October 10, 2010 from www.ct.gov/dph/lib/dph/hisr/pdf/facts_cthealth_disparities_2009.pdf.

Fairfield County QuickFacts from the US Census Bureau. Retrieved October 16, 2010 from

Http://quickfacts.census.gov/qfd/states/09/09001.html. Heath Disparities Report. (2009). Retrieved October 16,2010 from

ct.gov/dph/lib/dph/multicultural_health/2009/ct_healthdisparitiesreport.pdf. Stratton, A., Nepaul, A,, and Hynes, M. (2007). Issue Brief-Defining Health Disparities.. Retrieved

October 10, 2010 from ct.gov/dph/lib/dph/hisr/pdf/defining_health_disparities.pdf. Stratton, A., Nepaul, A,, and Hynes, M. (2007). Issue Brief-Race and Ethnicity Matters: concepts and

Challenges of racial and Ethnic Classifications in Public Health. Retrieved October 10, 2010 from ct.gov/dph/lib/dph/hisr/pdf/race_and_ethnicity_matters.pdf.

Yeo, G. (2010). Culture Med Ethnogeriatrics Overview Introduction. Retrieved November 6, 2010

from http://geriatrics.stanford.edu/culturemed/overview/introduction/.

Yeo, G. (2010). Culture Med Ethnogeriatrics Overview Patterns of Health Risk. Retrieved November 6, 2010 from http://geriatrics.stanford.edu/culturemed/overview/health_risk_patterns/.

http://www.ct.gov/dph/lib/dph/hisr/pdf/facts_cthealth_disparities_2009.pdf

http://quickfacts.census.gov/qfd/states/09/09001.html

http://geriatrics.stanford.edu/culturemed/overview/health_risk_patterns/


Power Point Presentation Created By:Joyce Cunneen, MSN, RNFairfield University School of NursingELDER Project Education Coordinator

Monica Starr, BSN, RNFairfield University School of NursingELDER Project Program Coordinator

Documents

Cultural Diversity ELDER Project Fairfield University School of Nursing Session 5 – Healthcare Disparities Supported by DHHS/HRSA/BHPR/Division of Nursing