Category Archives: Disparities
After decades of studies demonstrating that poor people and minorities are more likely than their white counterparts to live near health hazards such as toxic waste sites, landfills and congested highways, a new study in the journal PLOS One took a more refined look at a particular aspect in the area of “environmental injustice”: exposure to nitrogen dioxide. The pollutant—which is produced by cars, construction equipment and industrial sources—is linked to higher risk of both asthma and heart attack.
Using data from the 2000 Census, researchers determined that minorities are on average exposed to 38 percent higher levels of outdoor nitrogen dioxide. The gap varies depending where in the country they live, with the upper Midwest and the Northeast seeing the greatest disparities, as well as major cities. All told the disparity accounts for an additional 7,000 deaths due to heart disease annually.
"The biggest finding is that we have this national picture of environmental injustice and how it varies by state and by city," said Julian Marshall, a professor of environmental engineering at the University of Minnesota and one of the authors of the study, according to The Washington Post. "The levels of disparity that we see here are large and likely have health implications."
There are a number of possibilities to account for the disparities. For example, according to The Post, many “urban highways...were originally routed through minority communities that were politically easier to uproot than middle-class white neighborhoods” and “highways and landfills also depress nearby property values, meaning that people who can afford to live elsewhere do, while those who can't remain within their influence.”
Read the full story from The New York Times here.
>>Bonus Link: April is National Minority Health Awareness month. Read more of NewPublicHealth’s coverage of the annual event here.
April is National Minority Health Awareness Month. A look back at NewPublicHealth’s coverage of health disparities so far this year shows significant steps being taken to both identify and rectify the public health problem. From understanding why certain demographics are at greater risk for cancer, to how income gaps and ethnicity can collide, to how racism can affect overall health, here’s a review of some of the key stories we’ve reported on health disparities in 2014.
Mistrust, Perceived Discrimination Affect Young Adult Latinos’ Satisfaction with Health Care
Mistrust of the medical community and perceived discrimination can affect how satisfied young adult Latinos are with their health care, which in turn can influence health outcomes, affect participation in health care programs under the Affordable Care Act and contribute to disparities in health care access.
Black, Latina Breast Cancer Patients More Likely to Struggle with Health Care-Related Debt
Black and Latina breast cancer patients are far more likely than their white counterparts to have medical debt as a result of treatment or to skip treatments due to costs
Faces of Public Health: Louis W. Sullivan, MD
Louis W. Sullivan, MD, former U.S. Secretary of Health and Human Services under President George H.W. Bush, recently wrote a memoir, Breaking Ground: My Life in Medicine, that offers a wide view of Sullivan’s experiences as a medical student in Boston, the founding dean of the Morehouse School of Medicine in Atlanta and as the country’s chief health officer. NewPublicHealth recently sat down with Sullivan to discuss the book and his thoughts on the history and future of improving the nation’s health.
Study: Many Chronically Ill Adults Forced to Decide Between Medicine, Food
Chronically ill adults who, due to financial instability, lack consistent access to food are far more likely to underuse or even skip their medications completely, according to a new study in The American Journal of Medicine. Researchers analyzed data of 9,696 adults with chronic illness who participated in the National Health Interview Survey, finding that 23.4 percent reported cost-related medication underuse, while 18.8% percent reported food insecurity and 11 percent reported both. Hispanic and non-Hispanic blacks were at the highest risk.
Free to Be You and Me @ 40
Free to Be You and Me, a blockbuster hit album of the 70s and beyond, is still widely available on most music platforms. The television special, filled with skits on gender neutrality, is still a popular kids’ birthday gift, in part because many of the issues it speaks to—especially advancement opportunities and equality—are still being grappled with today.
Don’t judge a change agent by its vinyl. Free to Be You and Me, a blockbuster hit album of the 70s and beyond, and still widely available on most music platforms, was the "Born This Way" by Lady Gaga of its time, with songs, stories and ideas that told kids they could be whoever they wanted.
Stars who recorded songs for the album included Mel Brooks and Diana Ross. Songs included “Parents are People,” about the many professions open to men and women and sung by album creators Marlo Thomas and Harry Belafonte, as well as “It’s Alright to Cry” sung by football player Rosie Grier.
“We wanted to let children know that their wildest dreams were not just OK, but wonderful—and completely achievable,” said Thomas at a recent anniversary celebration for the album at the Paley Center for Media in New York City.
The television special, filled with skits on gender neutrality, is still a popular kids’ birthday gift, in part because many of the issues it speaks to—especially advancement opportunities and equality—are still being grappled with today:
- According to a recent Institute of Medicine report, African Americans live, on average, five years less than other Americans.
- According to the Society for Women’s Health Research, in some cases critical data on sex, age, race and ethnicity does not exist for new drugs, biologics and devices. For instance, women made up less than one-third of the participants in clinical trials on three different coronary stents (which open up blockages), even though 43 percent of patients with coronary heart disease are women.
- According to the Institute for Women’s Policy Research, in 2012 female full-time workers made only 77 cents for every dollar earned by men, a gender wage gap of 23 percent.
>>Bonus Link: Watch a panel discussion among several of the original Free to Be You and Me stars filmed earlier this month at the Paley Center.
A new infographic from the Office of the U.S. Surgeon General highlights collaborations within the federal government and between the health and healthcare sectors to help improve prevention outreach. These efforts are part of the cross sector National Prevention Strategy launched by the office several years ago.
Current examples of collaboration include Million Hearts, an initiative of the U.S. Department of Health and Human Services to prevent one million heart attacks by 2017. The initiative includes a commitment by close to 150 large private medical practices in the United States to get hypertension control rates above 80 percent in their communities.
You can also view the fully interactive infographic here.
>>Bonus Link: Read interviews and listen to podcasts about the National Prevention Strategy conducted with former and current U.S. Cabinet Secretaries and agency heads.
AHA Releases Stroke Prevention Guidelines for Women
For the first time, the American Heart Association (AHA) has released stroke prevention guidelines for women. The guidelines outline stroke risks unique to women and provide evidence-based recommendations on how best to treat them, including:
- Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin and/or calcium supplement therapy to lower preeclampsia risks.
- Women who have preeclampsia have twice the risk of stroke and a four-fold risk of high blood pressure later in life. Therefore, preeclampsia should be recognized as a risk factor well after pregnancy, and other risk factors such as smoking, high cholesterol, and obesity in these women should be treated early.
- Pregnant women with moderately high blood pressure (150-159 mmHg/100-109 mmHg) should be considered for blood pressure medication; expectant mothers with severe high blood pressure (160/110 mmHg or above) should be treated.
- Women should be screened for high blood pressure before taking birth control pills because the combination raises stroke risks.
- Women who have migraine headaches with aura should stop smoking to avoid higher stroke risks.
- Women over age 75 should be screened for atrial fibrillation risks; a risk factor for stroke.
Read more on prevention.
New Study Predicts Flu Severity
Researchers at St. Jude Children’s Research Hospital in Memphis say flu patients, regardless of age, who have elevated levels of three particular immune system regulators, called cytokines, early in the infection were more likely to develop severe flu symptoms and to be hospitalized than patients with lower levels of the same regulators. Study participants ranged in age from 3 weeks to 71 years.
The study, published in the American Journal of Respiratory and Critical Care Medicine, found that cytokine levels early in the infection were predictive of flu-related complications regardless of patient age, flu strain, the ability of the virus to replicate and other factors. The cytokines studied help to regulate inflammation caused by the body’s immune response to the flu until antibodies and T cells take over. Patients with the elevated cytokines seem to develop airway distress as a reaction to the immune response, a development separate from the effects of the flu virus. “We need to explore targeted therapies to address this problem separately from efforts to clear the virus, says study author Paul Thomas, PhD, an assistant member of the St. Jude Department of Immunology. Read more on flu.
Community Health Worker Model Can Reduce Hospital Readmissions
A new study in JAMA Internal Medicine reports on a community health worker (CHW) program developed at the University of Pennsylvania School of Medicine that hired people from the local community to help discharged patients navigate the health care system and address key health barriers, such as housing instability or food insecurity. The study found that the intervention improved patient experiences and health outcomes and reduced hospital readmissions.
The Penn team tested the model in a randomized trial with 446 hospitalized patients who were either uninsured or on Medicaid, and lived in low-income communities in which more than 30 percent of the population lived below the Federal Poverty Level. More than one-third of all readmissions to the hospitals participating in the study come from a five-zip code region. Patients in the trial received support from CHWs hired for traits such as empathy and active listening. The CHWs connected during a patient's hospital stay and continued after they were discharged to help with issues including scheduling doctor appointments, accessing medications, or finding child care or shelter. The control group received routine hospital care, medication reconciliation, written discharge instructions, and prescriptions from the hospital. The CHW group had a 52 percent greater chance of seeing a primary care physician within two weeks after being discharged from the hospital and scores measuring a patient's confidence in managing their own care in the future more than doubled in the CHW group. While the two groups had similar rates of at least one hospital readmission (15 percent vs 13.6 percent), the CHW group was less likely to have multiple readmissions (2 percent vs 6 percent in the control group). Read more on health disparities.
In January 2008, the Texas Health Institute received support from the Joint Center for Political and Economic Studies, a policy think tank with a particular focus on people of color, to track progress on efforts to advance racial and health equity through provisions of the Affordable Care Act (ACA). Shortly after the ACA became law, new support from the W.K. Kellogg Foundation and the California Endowment has led to a series of four reports that have assessed how well the law has been implemented in a way that addresses racial and ethnic health equity across five topic areas:
- Health insurance and exchanges;
- Health care safety net;
- Workforce support and diversity;
- Data, research and quality; and
- Public health and prevention.
To learn more about the reports’ findings, NewPublicHealth recently talked with Dennis Andrulis, PhD, MPH, the Senior Research Scientist at the Texas Health Institute and an Associate Professor at the University of Texas School of Public Health.
NewPublicHealth: How have the reports produced by the Texas Health Institute helped advance what we know about the ability of the Affordable Care Act to advance health equity?
Dennis Andrulis: The reports have provided an update of the progress, or lack thereof, in implementing race, ethnicity, language and equity provisions in the law. Did Congress appropriate dollars to support these provisions? If so, did the appropriations match the original requests and will they continue in future years?
The result is we have mapped out what we believe is a comprehensive overview of about 60 provisions related to health equity. Additionally, we have reported on the content and shape of related new initiatives, innovations, program support and other health care efforts.
NPH: What are some short-term and long-term efforts that your work indicated will help improve some health disparities?
Dennis Andrulis: First we need to have accurate and well-disseminated information about what’s in the law and the opportunities to change disparities that it provides.
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.
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.
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.