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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