Socioeconomic Status, Race and Health: Is Health Care Colorblind? Including a Special Focus On Black Child and Infant Health Status

Black Child Health Fact Sheet

Data retrieved Wen. June 18, 208 3:00 est from:
Children's Defense Fund

There were more than 4.1 million births in the United States in 2004, of which over 600,000, or about one in seven, were to Black mothers.

• A Black baby is born uninsured every five minutes. One out of every seven babies born uninsured is Black.
• One out of eight Black children is uninsured. Sixteen percent of all uninsured children are Black.
• Three-quarters of uninsured Black children have a working parent, and more than half have a parent who works full-time throughout the year.
• Black infants are more than twice as likely as White infants to die before their first birthday.
• Babies born to Black mothers are almost twice as likely as those born to White mothers to be low birthweight.
• Babies born to Black mothers are about 50 percent more likely than those born to White mothers to be preterm.
• Black children are almost 70% more likely than White children to lack a usual place for health care.
• More than one out of four Black two year olds is not fully immunized.
• Less than half of Black children are in excellent health. Black children are 20% less likely to be in excellent health than White children.
• One out of eight black children has asthma as compared to one out of thirteen White children.
• Among young Black children ages 2 to 4, one out of five has untreated tooth decay. Among Black children 6 to 8 years old, more than one out of three has untreated tooth decay.
• Black teenagers are more than twice as likely as White teenagers to have gone more than two years without seeing a dentist.
• One in three Black children is poor. The number of poor Black children increased by about 260,000 in the past five years to reach 3.8 million.
• Two out of five Black babies are born into poverty and more than half of all poor Black children live in extreme poverty.
• Out of the 5.6 million children living in extreme poverty in America, nearly 2 million are Black.

SOURCES:

Births: Department of Health and Human Services, National Center for Health Statistics, National Vital Statistics Report, Vol 55(1) (September 29, 2006), Table 32.

Infant deaths: U.S. Department of Commerce, Bureau of the Census, Health E-Stats, "Deaths: Final Data for 2004," Table 1

Immunization: Centers for Disease Control and Prevention, 2006 National Immunization Survey, 4:3:1:3:3:1 immunization series; Table 30

Health status and access (and one dental fact): Bloom B, Dey AN, Freeman G. Summary Health statistics for U.S. Children: National Health Interview survey, 2005. National Center for Health Statistics. Vital Health Stat 10(231), 2006.

Dental health status and access: Dye BA, Tan S, Smith V et al. Trends in oral health status: United States , 1988-1994 and 1999-2004. National Center for Health Statistics. Vital Health Stat 11(248), 2007.

Health insurance: U.S. Census Bureau, Revised 2006 Annual Social and Economic Supplement to the Current Population Survey (data revised by Census May, 2007). Calculations by the Children's Defense Fund

Poverty: U.S. Department of Commerce, Bureau of the Census, Current Population Survey, 2006 Annual Social and Economic Supplement, Detailed 2005 Poverty Tables, POV01, "Age and Sex of All People, Family Members and Unrelated Individuals Iterated by Income-to-Poverty Ratio and Race," and POV34, "Single Year of Age-Poverty Status"

Socioeconomic Status, Race and Health:

Is Health Care Colorblind?

An American Health Dilemma
(IVMS Required Textbook)

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A HIV/AIDS Basic Medical Science Presentation and Expert Discussion of the Politics of Treatment and Prevention in Sub-Sharan Africa

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Presentation Transcript for:

Socioeconomic Status, Race and Health: Is Health Care Colorblind?

Reference Resource:

Office of Minority Health and Health Disparities (OMHD)

An American Health Dilemma
(IVMS Required Textbook)

Prepared by: MARC IMHOTEP CRAY, M.D.

“It’s not just a health-care issue or a socio-economic status issue or a race issue. It is in part all of these things.”

Slide 2 : Socio-economic and health issues do not fully explain health status disparities in black folk It was only about 50 years ago that African-Americans were “able to participate in our society” “RESEARCH IS BEST INFORMED IN THE CONTEXT OF A NATION-CLASS-GENDER ANALYSIS”

Fueling Disparities : Fueling Disparities Patient-Level Variables Patient preferences, mistrust, comfort level Seeking treatment (or not) Adherence to treatment (or not) Effectiveness of treatment Healthcare Systems-Level Factors Language barriers Availability and access to health care Ability to navigate clinical bureaucracies Lack of insurance, differences in insurance Managed care limitations Care Process-Level Variables Bias, prejudice, stereotyping, clinical uncertainty Decisions made with limited time and information Effect of patient response on physician Institute of Medicine Report (2002) Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
Income and Health Percentage of persons with fair or poor health status by household income, United States, 1995. : Income and Health Percentage of persons with fair or poor health status by household income, United States, 1995.

Slide 5 : Wealth is important because we know that across all causes of morbidity (DISEASE) , economic status is the leading indicator of poor health

Slide 6 : Source: DHHS. Health, United States, 1998 Disparities: Infant Mortality Rates (Mothers > 20 Years of Age)

Slide 7 : What are some of the historical reasons for racial disparities in health? African-Americans are less compliant with treatment suggestions since they are less trusting of institutions like health-care systems Access to care is largely a function of health-insurance status, which is largely a function of employment status, which is largely a function of educational attainment So if that population has less education, it will have less access to health care

Slide 8 : The accumulated consequence of the Blackman’s history OF OPPRESSION plays itself out in a lot of statistics we see today: educational and wealth attainment, involvement in the criminal-justice system and health Poor Health status is a piece of THE FALLOUT OF OUR HISTORICAL OPPRESSION, an outward manifestation

Slide 9 : One problem is that the remedies are operating within separate silos THE problem is not amenable to having a solution in just one area It’s not going to be solved just by physicians, for example It’s not possible to detangle health from the social and economic factors

Slide 10 : Think of the care process, access to care comes first and then, among those with access, there’s utilization If those with access utilize it, do they get the same quality of care? And are they compliant once they are given a regiment? We find race disparities at each level But don’t physicians play a big role?

Slide 11 : employment, Geographies (rural) / mobility and socio-economics Even if they get access, African-Americans may be less inclined to use the services because of a historical or a contemporary mistreatment—or perceived mistreatment In Blacks there are access disparities because of:

Slide 12 : The Institute of Medicine of the National Academies report in 2002 [“Racial and Ethnic Unequal Treatment: Confronting Disparities in Health Care”] The Report Discovered race differences in the quality of care, for those who utilize it
Patient Perceptions: For the Average African American and Latino, How Big a Problem is…? : Patient Perceptions: For the Average African American and Latino, How Big a Problem is…? *Having Enough Doctors and Providers Near Home ^Difficulty Getting Care Because of Race/Ethnicity Source: Kaiser Family Foundation Survey of Race, Ethnicity and Medical Care: Public Perceptions and Experiences, 10/99

Slide 14 : How big a problem are HEALTH disparities? It depends on how you quantify it( remember, poverty and ignorance = death and disease) It is a very big problem from an equal rights perspective, There is a seven-to-eight-year life span difference between African-Americans and whites From a moral perspective, that’s significant (“right to life”) the economic costs haven’t yet been quantified
Biases in Medicine: Differences in Heart Surgery Rates by Race, Disease Severity, and Survival Benefit : Biases in Medicine: Differences in Heart Surgery Rates by Race, Disease Severity, and Survival Benefit Source: Kaiser Family Foundation: Key Facts on Race, Ethnicity and Medical Care, 1999

Slide 16 : Are you saying there’s racism within the health-care system? Yes Physician bias plays some role, but as the Institute of Medicine concluded, and we agree, this is not the only problem We know that the way the person is treated within the health system will influence whether they are compliant If you feel you were mistreated or got poor quality then you’re less inclined to be compliant

Patient Perceptions: Experience With Being Treated Unfairly When Seeking Medical Care Because of Race/Ethnicity : Patient Perceptions: Experience With Being Treated Unfairly When Seeking Medical Care Because of Race/Ethnicity Source: Kaiser Family Foundation Survey of Race, Ethnicity and Medical Care: Public Perceptions and Experiences, 10/99

Slide 18 : How much does MISTREATMENT AND POOR QUALITY OF CARE contribute to disparities in health between races? Compliance and treatment are an important part of determining health status disparities, but not the only part. Most Black people don’t have any health-care interaction during the year. The system is set up for curative not preventive medicine This is why physicians alone won’t solve health disparities They are not in a position to do it

Slide 19 : The quality of housing, whether you’re exposed to a lot of allergens / toxins Alcohol, tobacco and other drugs (atod) The amount of stress you encounter diet, exercise and proper rest What is happening in the physical environment is going to have much more of an effect on your health

Slide 20 : So how do we move toward health equality? We need cultural competency training for people in the health-care profession, Accreditation of hospitals and health systems should include awareness of health disparities as one criteria to determine accreditation We need to engender more trust of the health-care system among minorities, health education programs to try and get people to realize that you need to use the health-care system when it is available

Slide 21 : Fixing educational and wealth disparities of historical oppression will also address health disparities NO OTHER GROUP’S EXPERIENCES APPROACHES THE NEGATIVITY OF: AFRICAN AMERICAN’S 246 YEARS OF CHATTEL SLAVERY, 100 YEARS OF LEGAL SEGREGATION AND APARTHEID AND ONLY ONE GENERATION OF ”FREEDOM”

Slide 22 : It’s not just getting more African-American and Hispanic doctors It’s not that simple The solutions are societal.; correcting the fallout of slavery, segregation and present day race and class inequalities It’s improving opportunities for everyone and changing black people’s attitudes in terms of health behavior

Slide 23 : changing black people’s attitudes in terms of health behavior smoking, alcohol consumption, diet and exercise. Take tobacco and alcohol White adolescents are more likely than black adolescents to consume alcohol and tobacco But by the age of 30, it’s reversed There are higher rates of smoking and alcohol consumption for African-Americans—and Hispanics, for that matter—than for whites

Slide 24 : African-Americans go into adulthood, as they leave their families and go into society, they encounter socio-structural and institutional racism as major stressors They turn to drugging, drinking and smoking as a coping mechanism Whereas, smoking and drinking in white teens is youthful experimentation, and it begins to decline in adulthood What does that say? Best theory I’ve heard

Slide 25 : This is not the first time health disparities have bubbled to the top of the health-care agenda Still, this time it seems to have much more staying power and there are real resources being put into it A lot of people are much more aware of the health disparities, and there’s less denial about it We have made a lot of improvements in terms of awareness. That’s the first step I am cautiously optimistic because I take the long view and believe in self-reliance Do you think that we’ll see health disparities erased anytime soon? The end, Thank you for your attention


Further Study:

"YOUR CHILD CAN ATTEND MEDICAL SCHOOL FREE"

HIV and AIDS Education: Basic and Advanced/ Special Focus on sub-Saharan Africa

OUR STORY IN BRIEF! The Relationship Between America, Blacks, Health and Medicine

Medical Apartheid: From the Tuskegee Experiments to the Present: Text, Audio and Video

RBGz "Imhotep Virtual Medical School"-For Advance High School and College Pre Med Students

"The trailer that follows is a prime example of

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Black Infant Mortality:

Your Generation At Risk

Myth:
Infant mortality is higher for Blacks because so many black adolescents are giving birth.
Fact:
Studies show that Black mothers lose their babies more frequently than white women regardless of age..

Myth:
Black infant mortality is high because too many black mothers are single.
Fact:

Studies of the relationship between marital status and low birth weight (an indicator of infant mortality) show that Black women had higher rates than whites regardless of their marital status.

Myth:

Black infant mortality is high because too many black mothers are uneducated.

Fact:

Studies have shown as large a disparity between Black and white women among those with college education as among less-educated women. Studies of socioeconomic status and race show that while white women tend to have improved infant mortality rates when socioeconomic status improves, Black women do not.

Myth:

It's genetic. Black infant mortality is high because of genetic differences between blacks and whites.

Fact:

Studies have shown lower incidences of infant mortality among foreign-born black women, compared to US-born Black women, suggesting a non-genetic cause.

Myth:

Black infant mortality is high because too many black mothers do not receive adequate prenatal care.

Fact:

Studies show that prenatal care offers some limited improvement in Black infant mortality rates. To be effective, studies suggest that prenatal care must also include activities to reduce those risks that are highly prevalent among Black women or unique to Black women.

The more things change the more things stay the same. It was the same story when I was in med school some 20 plus years ago. It has been the same story for the past 500 years. "But don't believe me", Listen to the former U.S. Secetary of Education Bill Bennett, who has called for the killing of all Black Babies to reduce crime.

RBG Street Scholars Think Tank teaches Us how to protect and nurture Mother Afrika. Think with me for a moment. Isn't the cause really white supremacy ? Then why do we keep on clowning in white folk cloths ? Stick with the curriculum and you'll learn why; and moreover, how to decolonize the Afrikan Mind.

Link out for further study:

"The Most Scholarly Africentric Research, Analysis and Documentation of Black Health Disparities on the Web from a civil rights/legal prespective " Race, HealthCare and the Law, Editor/ Dr.Vernellia R. Randall, Professor of Law... "

Imhotep Virtual Medical School is a product of IMPF:

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MISSION: IMPF is a collective voice of African American, Native American, Hispanic American and progressive European American physicians and medical scientists. IMPF believes that the root cause of minority under-representation in United States medical schools is academic disadvantage borne by lack of access to high-quality high school and college preparation. Consequently, IMPF mission is to become the leading organizational force for parity in medical education by helping minority students develop the skills that will enable them to compete on a more equal footing in the medical school admission process. The Institute for Minority Physicians of the Future elucidates, distills and fuses educational psychology, information technology and undergraduate medical education data; and then develops programs, projects and products that serve to increase recruitment, admission and retention (RAR) of under-represented minorities (URM) in major United States medical schools. The ultimate goal being for these students to defend, define and develop medical careers that will be committed to the elimination of health disparities in racial/ethnic minorities and the poor.

THE INSTITUTE FOR MINORITY PHYSICIANS OF THE FUTURE

VISION STATEMENT: IMPF is a national professional educational organization representing the interest of minority high school and college students with the aptitude and desire to become physicians and medical scientists. Established in 1999, the collective body is committed to the vision of improving the health and well-being of future U.S. generations by increasing the minority physician/medical scientist workforce in such a way that the professions of medicine and biomedical research are reflective of the racial/ethnic profiles of the people physicians and medical scientists will serve. IMPF’s vision is directly linked to the AAMC data minority physicians are four times more likely than are others to practice in undeserved communities. Such communities are more frequently than not overwhelmingly populated by racial/ethnic minorities.

THE INSTITUTE FOR MINORITY PHYSICANS OF THE FUTURE:

CORE STRATEGY: IMPF strategy is to identify, inform, recruit, assist, advise and educate promising African-American, Native-American, Hispanic-American, high school and college students in order to increase the number of minority medical students and PhD candidates in United States medical schools.

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