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December 3, 2001 1
Introduction to Public Health : Minority Introduction to Public Health : Minority Health MPH 600Health MPH 600Guest LecturersGuest Lecturers
L. Robert Bolling, Former Director
Henry C. Murdaugh, Director
For Christopher Buttery, MD, MPH
December 3, 2001September 28, 1998
2
Minority Populations Demographics
Racial and Ethnic Minorities Comprise 24% of the state’s total population
African-Americans/Blacks 1.5 million (20%)Asian/Pacific Islanders – 248,00,000 (3.6%)Hispanics/Latinos – 251,000 (3.7%)Native Americans -- 19,000 (<1%)
December 3, 2001September 28, 1998
3
Background
1985 Report of the U.S. Secretary of Health and Human Services’ Task Force on Black and Minority Health.
Virginia Minority Health Initiative.
December 3, 2001September 28, 1998
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Virginia Minority Health Initiative
Minority Health Advisory CommitteeProvides --
Recommendations and information for improving minority health to the Commissioner, VDH, and other agencies and organizations.
Office of Minority HealthProvides --
Policy development
Resource development
Data/Information
Technical Assistance
December 3, 2001September 28, 1998
5
Virginia’s African-American Health Status
Available data for Virginia shows a substantial disparity or ‘gap’ between health
indices for Blacks and Whites.
December 3, 2001September 28, 1998
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Virginia’s African-American Health Status Indicators
Life expectancy, infant mortality, low birth weight and teenage pregnancy are considered reliable indicators or measures of health status and quality of life.
The burden of chronic disease provides another reliable index for measuring health status.
December 3, 2001September 28, 1998
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The Disparity or “Gap”(Adults)
Heart DiseaseCancerCerebrovascular Disease/StrokeDiabetesUnintentional InjuriesHIV/AIDS
*State Health Commissioner's Minority Health Advisory Committee, Initial Fact Sheet, 1990
December 3, 2001September 28, 1998
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Comparison of Life Expectancy by Race, Virginia, 1992
Black life expectancy is six years less than for whites.
Race Years
Black 71
White 77
Total 75
Rounded to the nearest year, Center for Health
Statistics, Virginia Department of Health 68
69
70
71
72
73
74
75
76
77
Years
BlackWhiteTotal
December 3, 2001September 28, 1998
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Comparison Heart Disease Mortality Rate by Race (age-adjusted/100,000 pop)
Virginia, 1995
020406080
100120140160180200
1995
Black
White
Total
HP 2K(Black)HP 2K(All)
POP RATE
Black 186.7
White 127.8
Total 137.6
HP 2K (Black)115.0
HP 2K (All)100.0
Source: Virginia’s Plan for Cardiovascular Disease Prevention, 1998-2000
December 3, 2001September 28, 1998
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Comparison Breast Cancer Incidence and Mortality Rates, By Race (age-adjusted/100,000 pop)
Virginia, 1994 Although the incidence of breast cancer is comparable across racial populations in Virginia, the Black death rate doubles the white rate.
Race Incidence Rate
Black 94.5 29.6
White 98.1 15.3
Total 97.5 21.5
HP 2K (Black) 25.0
HP 2K (All) 20.6Source: Breast and Cervical Program, VDH
0102030405060708090
100
Incidence Mortality
Black
White
Total
December 3, 2001September 28, 1998
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Comparison Stroke Mortality Rates by Race (age-adjusted/100,000 pop)
Virginia, 1994
05
101520253035404550
Rate
BlackWhiteTotal
POP RATE
Black 48.2
White 25.7
Total 29.7
Source: Virginia’s Plan for Cardiovascular Disease Prevention, 1998-2000
December 3, 2001September 28, 1998
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Comparison of Diabetes-Related Mortality (age-adjusted) by Race, Virginia, 1996
RATEBlack
74.4White
31.2Total
37.8
Source: Diabetes Control Surveillance Project, Survey and Evaluation Research Laboratory, Virginia
Commonwealth University, 1998
0
10
20
30
40
50
60
70
80
Rate
BlackWhiteTotal
December 3, 2001September 28, 1998
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The Disparity or ‘Gap’ (Children)
Infant MortalityLow Birth WeightTeenage PregnancyLead, AsthmaTobacco Use
December 3, 2001September 28, 1998
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Infant Mortality Rate per 1,000 Live Births
Virginia, 1991-1998
Source: Center for Health Statistics
02468
101214161820
1991 1992 1993 1994 1995 1996 1997 1998
Rat
e pe
r 1,
000
Total White Black Other
December 3, 2001September 28, 1998
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Resident Low Weight Live BirthsPercent of Total Live Births
Virginia, 1991-1998
0
2
4
6
8
10
12
14
1991 1992 1993 1994 1995 1996 1997 1998
Per
cent
age
Total White Black Other
Source: Virginia Center for Health Statistics
December 3, 2001September 28, 1998
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Resident Teenage PregnanciesVirginia, 1976-1998
0102030405060708090
Year
Rat
e pe
r 1,
000
Pop
ulat
ion
WhiteBlackTotal
Source: Virginia Center for Health Statistics
December 3, 2001September 28, 1998
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0102030405060708090
100
Cas
es p
er 1
00,0
00
1997
White
Black
Other
Childhood Lead Poisoning per 100,000Children Aged 0-15
By Race
Black children are 9.7 times more likely to have lead poisoning than white children.
December 3, 2001September 28, 1998
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Reported HIV and AIDS Cases By Race,
1990 to 1997 (Percentage)
0%
50%
100%
1990
1992
1994
1996
AIDS by Race, 1990-97
Other
Hispanic
White
Black0%
100%
1990 1993 1996
HIV by Race, 1990-97
Other
Hispanic
White
Black
December 3, 2001September 28, 1998
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Total Syphilis Cases and Racial Percentage, 1990-1997
Year Cases % Black
1990 1,551 91.6%
1991 1,622 90.5%
1992 1,347 92.2%
1993 1,268 91.3%
1994 1,409 90.3%
1995 1,144 91.4%
1996 798 90.9%
1997 615 88.1%
0102030405060708090
100
1990
1992
1994
1996
Black
White
Other
December 3, 2001September 28, 1998
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African-Americans Eligible for Medicaid, 1996
0100000200000300000400000
Other White Black
Number Eligible
The Statistical Record of the Virginia Medicaid Program, October 1996
December 3, 2001September 28, 1998
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Percent of Total Uninsured by Race, Virginia 1993 and 1996
0
10
20
30
40
50
60
70
1993 1996
Black
White
Other Races
JCHC Staff Analysis: ‘93 & ‘96 Health Care Access Surveys
December 3, 2001September 28, 1998
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Percent of African-Americans by Type of Insurance Status
0
10
20
30
40
50
60
70
1993 1996
Comp
Non-Comp
Unisured
JCHC Staff Analysis ‘93 & ‘96 Health Care Surveys
December 3, 2001September 28, 1998
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Vignettes 39 yr old Honduran
pregnant mother Employed as housekeeper
in local hotel No insurance Limited English
Proficiency Goes to local for profit
hospital Blood in stool
54 yr old African-American married male
Diabetic on insulin Slightly overweight Manager at local factory Insured Blood in stool
December 3, 2001September 28, 1998
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Discussion Questions?
Is there a difference between community health and minority health?
How can we eliminate health disparity in access to health care?
How is access to health care for minority and underserved populations financed in Virginia?
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Models that Work
Virginia Baptist General Convention Collaborative project with the Virginia Department of Health
African-American Fatherhood CampaignAlliance of Black Churches
December 3, 2001September 28, 1998
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Why Do these Programs Work?
Adequately Funded: Federal, State, Local and Privately
Community-BasedCulturally CompetentAccessible
December 3, 2001September 28, 1998
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Effective Strategies to Improve Minority Health
Support and Collaborate with Your State Offices of Minority Health
Establish National Umbrella Advocacy Organization with Sole or Primary Focus on African-American Health Issues
Partnership with Other Minority Health Entities
Promote State Legislation Action to Address Minority Health
December 3, 2001 28
Be Active Now Each One, Reach One
Tsamaya Sentle!Tsamaya Sentle!
