Category Archives: Health disparities

Nov 25 2013
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Recommended Reading: Q&A with APHA President-elect Shiriki Kumanyika

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Today is Public Health Thank You Day 2013, when Research!America and other leading public health organizations recognize the public health professionals working to improve health where we all live, learn, work and play.

Among the biggest names in public health at the moment is Shiriki Kumanyika, PhD, MPH, a University of Pennsylvania professor who earlier this month became the president-elect of the American Public Health Association (APHA). In a recent Q&A on APHA’s Public Health Newswire blog, Kumanyika spoke about the overall landscape of public health and gave her thoughts on particular issues.

One of the big takeaways from the APHA annual meeting earlier this month—where she was named president-elect—was how APHA is shifting its focus to concentrate more on being an action- and goal-oriented organization, according to Kumanyika.

“We are going to be more convincing about the importance of a focus on prevention and wellness, while making better use of scientific evidence and creating a greater sense of urgency around health equity issues,” she said. “I think that, over time, this new positioning in the public arena will really enhance the sense of community among our thousands of diverse members, attract more members and align our combined efforts for greater overall impact.”

Kumanyika also has particular ideas on the greatest opportunities for improving health in African-American communities, especially when it comes to nutrition and obesity prevention. Not only are unhealthy foods too easily available in the average black community but, when compared to other communities, the situation is even more troubling, with black communities seeing more advertising for unhealthy food. The answer is targeted efforts to promote healthier alternatives.

However, she also noted how food and nutrition present their own particular public health obstacles.

“Food is a particularly complex area; we can’t treat it like tobacco and tell people to avoid it altogether. The changes we need are more complicated and will have huge implications across the spectrum from agriculture to environmental sustainability,” she said. “We have to make both a public health case and a business case for a healthier food supply and for marketing healthier foods and beverages. We have a tremendous opportunity to make progress that will change the food and health landscape for the population at large if we do our health diplomacy well.”

Read the full interview on Public Health Newswire here.

Nov 22 2013
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Public Health News Roundup: November 22

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CDC Report Finds Health Disparities, Inequalities Persist across the U.S. Population
The U.S. Centers for Disease Control and Prevention (CDC) has released a new report examining the disparities in mortality and disease risk as they relate to income, education level, sex, race, ethnicity, employment status and sexual orientation. CDC Health Disparities and Inequalities Report — United States, 2013 is the second CDC report to take this wide look at the U.S. population. Among its key findings:

  • The overall birth rate for teens 15-19 years old dropped 18 percent from 2007 to 2010, although it varied widely from state to state
  • People who are Hispanic, are low wage earners, were born outside of the United States, have no education beyond high school, or are male are more likely to work in an occupation in which workers are more likely than average to be injured or become ill
  • Binge drinking is most common for people ages 18-34, men, non-Hispanic whites and people with higher household incomes

“It is clear that more needs to be done to address the gaps and to better assist Americans disproportionately impacted by the burden of poor health,” said Chesley Richards, MD, MPH., director of CDC’s Office of Public Health Scientific Services, which produced the report. “We hope that this report will lead to interventions that will allow all Americans, particularly those most harmed by health inequalities, to live healthier and more productive lives.” Read more on health disparities.

HUD Grants to Help Transform Distressed Communities into Thriving Communities
The U.S. Department of Housing and Urban Development (HUD) is granting approximately $4.37 million to help nine areas transform their public or other HUD-assisted housing and distressed neighborhoods into thriving communities. Fifty- two communities had applied for the Choice Neighborhoods Planning Grants. The agency’s Choice Neighborhoods Initiative supports locally-driven economic developments to create renewed, sustainable communities, with a focus on creating energy-efficient, mixed-income housing that has easy access to high-quality services, education programs, early learning programs, public assets and public transportation. Full details on each community can be found here. Read more on housing.

Study: Certain Health Behaviors Tied to Complication-free Pregnancies
Women who engage in certain healthy behaviors—and avoid certain unhealthy ones—are more likely to have complication-free pregnancies, according to a new study in the journal BMJ. An analysis of health data on more than 5,600 women found that eating fruit, having a healthy weight, having lower blood pressure, having a job, and stopping drug and alcohol abuse at 15-20 weeks of gestation "may increase the likelihood of normal pregnancy outcomes," according to Lucy Chappell, of the Women's Health Academic Center of King's College London. The most common pregnancy-related complications are babies who were too small for their gestational age, high blood pressure, preterm birth and preeclampsia. Read more on maternal and infant health.

Oct 30 2013
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Public Health News Roundup: October 30

HPV Vaccines Less Effective in African-American Women than in White Women
Perhaps because of their lower participation rates in clinical trials, African-American women are less likely to benefit from available human papillomavirus (HPV) vaccines that guard against cervical cancer, according to new findings presented at the 12th annual International Conference on Frontiers in Cancer Prevention Research. The two most popular vaccines in use protect against infection by HPV 16 and HPV 18, which are responsible for about 70 percent of cervical cancers. However, these two subtypes are half as likely to be found in black women as they are in white women. Researchers found that the most common infections for white women are from subtypes 16, 18, 56, 39 and 66; the most common for black women are 33, 35, 58 and 68. "Since African-American women don't seem to be getting the same subtypes of HPV with the same frequency, the vaccines aren't helping all women equally," said study author Adriana Vidal, Ph.D., assistant professor of obstetrics and gynecology at Duke University School of Medicine. Read more on health disparities.

San Francisco Proposes Tax on Soda, Other Sugary Beverages
In an effort to curb the growing rate of obesity and obesity-related health issues, a San Francisco, California city supervisor has proposed a ballot measure that would impose a 2-cents-per-ounce tax on soda and other sugary beverages with at least 25 calories per ounce. This would be the first and strongest such city measure in the country, amounting to an additional 24 cents for a normal 12-ounce can of soda. Supervisor Scott Wiener said the tax proceeds, which he estimates would be $30 million annually, would go toward physical education and healthy lunch programs in city schools, as well as city parks, recreation programs and community health organizations. The California cities of Richmond and El Monte last year failed to enact similar taxes. A ballot measure requires a two-thirds majority to pass. "We know that this will be a long road," said Wiener. "This type of proposal has occurred in other cities and the beverage industry always comes out full guns blaring, so we're going to need to pull together to make sure that this wins." Read more on obesity.

Study: Young Cancer Patients at Increased Risk for Suicide
The stress of a cancer diagnosis means that teens and young adults who are diagnosed should be carefully monitored for behavior changes and other issues that could be a sign of suicidal thoughts, according to a new study in the Annals of Oncology. While there is an elevated risk of suicide for cancer patients of all ages, “because adolescents and young adults are still developing their coping strategies for stress, they may be more affected than adults when facing major adversity such as a cancer diagnosis," said lead researcher Donghao Lu, from the department of medical epidemiology and biostatistics at the Karolinska Institute in Stockholm, Sweden. Lu and his team found that Swedes ages 15-30 with a cancer diagnosis were at a 60 percent greater risk of suicide or attempted suicide, compared to people in the same age group but without cancer; in the first year after the diagnosis the risk was 150 percent higher. Lu said the findings indicate the need for greater communication and cooperation among medical professionals, psychological professionals, family members and social workers. Read more on cancer.

Oct 23 2013
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Public Health News Roundup: October 23

Medical Groups Issue New Definitions for Stages of Pregnancy
With a goal toward improving newborn outcomes and reducing non-medically related deliveries, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) are recommending four new definitions of ‘term’ deliveries:

  • Early Term: Between 37 weeks 0 days and 38 weeks 6 days
  • Full Term: Between 39 weeks 0 days and 40 weeks 6 days
  • Late Term: Between 41 weeks 0 days and 41 weeks 6 days
  • Post term: Between 42 weeks 0 days and beyond

Research over the past several years finds that every week of gestation matters for the health of newborns, and that babies born between 39 weeks 0 days and 40 weeks 6 days gestation have the best health outcomes, compared with babies born before or after this period. ACOG and SMFM encourage physicians, researchers, and public health officials to adopt these new precisely-defined terms in order to improve data collection and reporting, clinical research, and provide the highest quality pregnancy care. ACOG is a partner with the U.S. Department of Health and Human Services on “Strong Start,” a public awareness campaign to reduce unnecessary elective deliveries before 39 weeks’ gestation. Read more on maternal and infant health.

Poll Shows Americans Strongly Supporting Steps to Reduce Racial and Ethnic Inequality
A new poll conducted by the Center for American Progress and PolicyLink, and funded by The Rockefeller Foundation, finds that Americans are much more open to diversity and supportive of steps to reduce inequalities between racial and ethnic groups than has been previously thought. The poll was conducted by landline and cellphone in June and July among close to 3,000 U.S. citizens across the country. Some key findings of the poll include:

  • Positive sentiments about opportunities from rising diversity tend to outweigh negative concerns.
  • Sixty-nine percent of responders said that a bigger, more diverse workforce will lead to more economic growth and that diverse workplaces and schools will help make American businesses more innovative and competitive.
  • More than 7 in 10 Americans support new steps to reduce racial and ethnic inequality in America through investments in areas such as education, job training and infrastructure improvement. Among Whites, the level of support was 63 percent.

Read more on health disparities.

CDC: Flu Season Slow So Far…But Should Pick Up Soon
While the flu season has seen relatively few cases so far, public health officials expect that to change soon and are heavily recommending that anyone who has yet to be vaccinated go ahead and do so. Joe Bresee, MD, chief of the epidemiology and prevention branch in the U.S. Centers for Disease Control (CDC) and Prevention's Influenza Division, said 135 to 139 million doses of vaccine should be available; the number of people who receive the vaccine annually has risen since 2009. "It's edging up in most groups, which is really gratifying, especially in some of the high-risk groups like pregnant women and kids. We are seeing good gains over the last four or five years," he said. "But we have a long way to go. Still only half of Americans get vaccinated. Vaccine is still the single best thing folks can do to prevent flu." Read more on the flu.

Oct 2 2013
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Exploring the Intersection of Health, Place and Economic Justice

file Brian Smedley, Joint Center for Political and Economic Studies

On Wednesday October 2nd, the Joint Center for Political and Economic Studies held its third annual National Health Equity Conference, PLACE MATTERS: Exploring the Intersections of Health and Economic Justice. The Joint Center for Political and Economic Studies was founded in 1970 and is the only research and public policy institute that focuses exclusively on social justice issues of particular concern to African Americans and other communities of color.

The conference focused on the relationship between community development and the creation of healthy spaces and places, and convened key stakeholders, including grassroots leaders, elected officials, researchers, public health practitioners, policymakers, community development practitioners, and community organizers. The conference had several goals, including to:  

  • Illuminate the mechanisms through which neighborhood conditions directly and indirectly shape the health of children, youth, and families, and document differences in neighborhood conditions resulting from residential segregation;
  • Identify common goals and strategies of individuals and organizations working in the community development sector and the health equity sector;
  • Elevate promising strategies to improve and sustain neighborhood conditions for health that draw upon effective approaches employed in the community development and health equity sectors; and
  • Explore means to better communicate these strategies to key audiences, such as community-based development and health equity organizations, public health practitioners, planners, and elected officials.

Leaders at the Joint Center say that by convening national and local leaders, including individuals at the forefront of community development and health equity movements, they hoped to raise awareness regarding community conditions that shape health and develop policy solutions at the intersection of place and health, particularly as it pertains to people of color and health equity.

NewPublicHealth spoke with Brian Smedley, PhD, Vice President and Director of the Joint Center’s Health Policy Institute about the critical issues of community health and its relationship to health equity.

NewPublicHealth: What do we know so far about the impact of place on health, and what do we still need to learn?

Brian Smedley: There’s a large and growing body of research that demonstrates the relationship between the places and spaces where people live, work, study, and play and their health status, and what we’ve been able to determine is that there are many characteristics of neighborhoods, schools and work places that powerfully shape health.  Just as an example, more and more people are paying attention to this concept of food deserts — many communities in the United States that don’t have geographic access to healthy foods.  And not only do people have to travel a long distance to access these foods, but they’re often financially out of reach as well.

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Sep 23 2013
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Public Health News Roundup: September 23

UN: Improved Access to HIV/AIDS Treatment Reduces Number of AIDS-related Deaths
The United Nations’ annual report on HIV infections and AIDS related-deaths around the world concluded that increased access to treatment in poorer and middle-income countries has led to positive health outcomes. “AIDS-related deaths in 2012 fell to 1.6 million, down from 1.7 million in 2011 and a peak of 2.3 million in 2005. And the number of people newly infected with the disease dropped to 2.3 million in 2012 down from 2.5 million in 2011.” The executive director of UNAIDS, Michel Sidibé, said that the international community is well on its way to surpass the 2015 goals of expanding access to treatment. Read more on the public health impact of AIDS.

Racism Leads to Negative Effects on Mental Health of Children and Teens
A new report published in the journal Social Science & Medicine examines the link between the mental health and well-being of youth ages 12-18 and racism. The review shows that being a victim of racial discrimination can lead to low self-esteem, reduced resilience, and increased behavior problems. There was also evidence of increased risk of poorer birth outcomes for children when mother experienced racism while pregnant. These types of detriments to children and teen’s mental health and well-being can lead to larger problems in terms of engagement in education and employment later in life, according to study authors. Read more on health disparities.

Positive Relationships May Help Break the Cycle of Maltreatment
In a special supplement released by the Journal of Adolescent Health, investigations on the effects of safe, stable, nurturing relationships found that these types of relationships could help break the cycle of child maltreatment that is often passed along from parents to children. Findings also showed that supportive and nurturing relationships between adults can help protect children as well. This study can provide helpful prevention strategies for breaking the cycle of maltreatment and promoting improved health in the long term. Read more on violence prevention.

Sep 13 2013
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Public Health News Roundup: September 13

Higher Education Linked to Better Obesity Rates for Women in Poorer Areas
Higher education is a key factor that helps protect women in economically disadvantaged areas from obesity, according to a new study in the American Journal of Health Promotion. “It is possible that education is a marker of an individual’s access to health information, capacity to assimilate health-related messages, and ability to retain knowledge-related assets, such as nutrition knowledge,” wrote the study’s authors. Previous studies have shown that women living in area with fewer economic resources have higher body mass index (BMI) than other women. The results indicate that both low education and personal income should be addressed by obesity prevention initiatives. Read more on obesity.

Regular Exercise May Help Decrease Depression
Increases in exercise may be linked to decreases in depression, according to a new review of existing research by The Cochrane Library. The researchers found people with depression who also exercised saw a “moderate” reduction in their symptoms when compared to people who did instead used relaxation techniques or received no treatment. Antidepressant medications and psychotherapy are the most common treatments for depression, which affects about 10 percent of Americans, according to the U.S. Centers for Disease Control and Prevention. More research is needed to better understand the relationship between exercise and depression symptoms. Still, Madhukar Trivedi, MD, a professor of psychiatry at the UT Southwestern Medical Center in Dallas, who was not a part of the study, said one of the keys is making sure patients stick with the exercise regimen. "Once people are prescribed exercise or they choose exercise, the big challenge is to make the exercise real," he said. "If the recommendation from the treating clinician is that you should be exercising with some frequency and intensity…it's important that the patient follow that regimen week after week.” Read more on mental health.

Predominantly Black Nursing Homes Deliver Lower Levels of Care, Perform Worse Financially
Nursing homes that are predominantly populated by black residents deliver overall poorer care and are less successful financially than homes with few or not minority residents, according to a new study in Health Services Research. The study looked at issues such as the ratio of nursing staff to patients, success in preventing pressure ulcers, help with walking, help with getting out of bed, prevention of urinary tract infections, the incidence of medication errors and citations by governmental agencies. However, the study noted that black and white patients living in the same facilities received equal treatments, meaning the disparity is not due to any biases of health care workers. One factor leading to the disparity could be the fact that older black Americans are more likely to rely on Medicaid, which means lower reimbursement rates. Still, Latarsha Chisholm, assistant professor at the University of Central Florida and study author, believes something more must be at play. "It isn't only the financial performance [of nursing homes] that affects performance," she said. "There has to be something else affecting quality. I want to understand what management practices promote improved care in nursing homes with high proportions of minorities that don't have disparities in care.” Read more on health disparities.

Sep 12 2013
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Recommended Reading: Giving Context to ‘200,000 Preventable’ Cardiovascular Deaths

Have you heard the story about the Prevention and Public Health Fund? A “no” wouldn’t be surprising.

Have you heard the story about the almost 200,000 preventable deaths in the United States each year due to heart disease and stroke? Probably so.

The latter was big news last week, inspiring headlines and handwringing across the country. Men are twice as likely as women to die of preventable cardiovascular disease. Blacks are twice as likely as whites. Southerners are at far greater risk.

Most of the stories emphasized how all this unhealthy living is the result of unhealthy lifestyle choices. But is that the whole story?

“Largely absent from most of the stories covering the study was context—a hard look at the social and environmental conditions that help explain the findings—as well as some explanation of what it might take to really change things and prevent large numbers of needless deaths.” They also tended to suggest “that poor health is essentially a personal moral failing, while ignoring the vastly different realities that exist in different communities in this country.”

That’s the thesis of a recent Forbes opinion piece, which looks past the round number of “200,000” and other statistics detailed by the U.S. Centers for Disease Control and Prevention (CDC), and points attention to the very real obstacles to healthy living that far too many people face.

The CDC study also discussed the importance of addressing the economic and social determinants that influence the health of individuals and communities (though this went largely unacknowledged in most media accounts, according to the Forbes piece). The CDC pointed out strategies that help create conditions for healthier living, including policy changes that increase access to health care, that give people healthy local food options and that build walkable communities—changes that can only be made by communities, not individuals.

That brings us back to the Prevention and Public Health Fund. Created by the Affordable Care Act, the Fund’s grantees have spent the past three years doing all these things—helping states, cities and tribes create safer, healthier communities.

“That’s a story that needs to be told, with context.”

>>Read the full piece, “200,000 Preventable Deaths A Year: Numbers That Cry Out For Action -- And Better Reporting.”

Sep 5 2013
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Public Health News Roundup: September 5

‘Hyper-vigilance’ Over Racial Disparities May Be a Factor in Higher Hypertension Rates for Black Americans
“Hyper-vigilance” related to race consciousness may be a factor in why black Americans have a disproportionately high rate of hypertension, according to a new study in the American Journal of Hypertension from researchers at the Johns Hopkins University School of Medicine. While it’s long been known that blacks have, on average, higher blood pressure, the exact environmental factors that contribute to the higher rates are not fully understood, according to Lisa A. Cooper, MD, MPH, a professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine and the study’s senior author. “Hyper-vigilance [is] a heightened awareness of their stigmatized status in society and a feeling that they need to watch their backs constantly,” she said. “African-Americans have higher blood pressure, and it has been difficult to explain why this is true. It doesn’t appear to be genetic, and while things like diet, exercise and reduced access to health care may contribute, we think that a tense social environment, the sense of being treated differently because of your race, could also possibly explain some of what’s behind the higher rates.” Read more on health disparities.

Survey: Most Women Don’t Know their Personal Breast Cancer Risk
A new survey of more than 9,000 women shows that far too few have an accurate idea of their personal risk of developing breast cancer in their lifetime. Study researcher Jonathan Herman, MD, an obstetrician and gynecologist at Hofstra North Shore-LIJ Medical School in New Hyde Park, N.Y., found that only 9.4 percent knew their risk level, nearly 45 percent underestimated their level and nearly 46 percent overestimated their level. The survey also found that about four in 10 women had never even discussed their personal breast cancer risk with a physician. On average, women have a 12 percent lifetime risk of breast cancer, with that number climbing 20 percent if their mother had breast cancer. The BRCA mutations that increase breast cancer risk push the risk to about 70 percent. Mary Daly, MD, chair of clinical genetics at Fox Chase Cancer Center, in Philadelphia, and director of its risk assessment program, said it is critical that women researcher their family history related to breast cancer in order to determine whether they are following the best possible screening schedule. Read more on cancer.

Harsh Verbal Discipline of Teens Only Makes Behavior Worse
Harsh verbal discipline of teenagers not only isn’t effective at changing bad behaviors, but can in fact make them worse, according to a new study in the journal Child Development. "Most parents who yell at their adolescent children wouldn't dream of physically punishing their teens," said study author Ming-Te Wang, an assistant professor with the department of psychology at the University of Pittsburgh School of Education. "Yet, their use of harsh verbal discipline—defined as shouting, cursing or using insults—is just as detrimental to the long-term well-being of adolescents.” A recent survey indicates that about nine in 10 parents have admitted to such behavior. The study found that the emotional pain and discomfort cause by harsh parental verbal abuse can increase anger while dropping inhibition, which in turn can promote behaviors such as lying, cheating, stealing and fighting. It also found that the concept of “parental warmth”—as in a parent was yelling out of love or for the child’s own good—didn’t make things any better. "Parents who wish to modify their teenage children's behavior would do better by communicating with them on an equal level…and explaining their rationale and worries to them,” said Wang. “Parenting programs are in a good position to offer parents insight into how behaviors they may feel the need to resort to, such as shouting or yelling, are ineffective and or harmful, and to offer alternatives to such behaviors." Read more on pediatrics.

Aug 14 2013
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Tobacco-Related Health Equity: What Will It Take?

Tomorrow from 12 p.m. to 2 p.m. EST Legacy will hold a special online panel discussion as part of the Kenneth E. Warner Lecture Series that puts a spotlight on the social influences on tobacco use and tobacco-related death and disease. The panel will discuss the disproportionate impact of tobacco by race, ethnicity, sexual orientation and socio-economic status to help identify strategies to tackle tobacco-related health inequities.

>>View the live webcast Thursday, August 15, from 12 p.m. to 2 p.m. EST.

Paula Braveman, MD, MPH, a panelist as well as director of the Center on Social Disparities in Health at the University of California San Francisco and Research Director of the Robert Wood Johnson Foundation Commission to build a Healthier America, spoke with NewPublicHealth about the upcoming discussion.

“The purpose of the discussion,” said Dr. Braveman, “is to give wider attention to disparities in tobacco-related health consequences, and to reach a wider audience on the issue of disparities so that it can be dealt with in a more focused way than it has been up until now.”

Dr. Braveman says that a targeted focus is important for ethical and economic reasons. “The consequences of disparities in smoking and tobacco-related illness take a huge economic toll in terms of lost worker productivity and medical expenses that otherwise would not have been needed and in terms of suffering and loss of life. Using the disparities frame helps us to see that the health condition of people who are best off should be possible for everyone.”

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