Docstoc

Racism Stress and Health Inequity

Document Sample
Racism Stress and Health Inequity Powered By Docstoc
					Connecting the Dots

RACISM, STRESS, AND HEALTH
INEQUITY
A Tale of Two Babies




                  Elijah
 Joseph
The Cycle Begins

             Joseph was born
           full-term (40 weeks)
            and a robust 8 lbs


                Elijah was
             premature and
            weighed just 2 lbs
Pre-term Delivery

       Monroe County Outside the                                                  Inside the Crescent
               Crescent                                          14.0

14.0
                                                                 12.0
12.0
                                                                 10.0
10.0

                                                                  8.0
 8.0

                                                                  6.0
 6.0

                                                                  4.0
 4.0


 2.0                                                              2.0


 0.0                                                              0.0
       2003          2004        2005       2006          2007          2003          2004        2005       2006          2007

              African American      White          Hispanic                    African American      White          Hispanic
Low Birth Weight

       Monroe County Outside the                                                  Inside the Crescent
               Crescent                                          14.0

14.0
                                                                 12.0
12.0
                                                                 10.0
10.0

                                                                  8.0
 8.0

                                                                  6.0
 6.0

                                                                  4.0
 4.0


 2.0                                                              2.0


 0.0                                                              0.0
       2003          2004        2005       2006          2007          2003          2004        2005       2006          2007

              African American      White          Hispanic                    African American      White          Hispanic
Infant Mortality

        Monroe Co Outside the                                             Inside the Crescent
             Crescent                                    20.00

20.00
                                                         17.50
17.50
                                                         15.00
15.00
                                                         12.50
12.50
                                                         10.00
10.00

                                                          7.50
 7.50

                                                          5.00
 5.00


 2.50                                                     2.50


 0.00                                                     0.00
        02-'04        03-'05      04-'06        05-'07           02-'04        03-'05      04-'06        05-'07

          African American     White       Hispanic                African American     White       Hispanic
  What are Health
  Disparities?
“Differences that occur by gender, race or
ethnicity, education or income, disability,
geographic location, or sexual orientation.”

Inequity and inequality in…
     • Access, utilization and quality of care
     • Specific health outcomes
     • Health status
US Dept. of Health and Human Services (2000)
Carter-Pokras and Baquet (2002)

                                               August 5, 2008
Health Status by Race
             Fair or Poor Reported Health Status by Age Group and Race –
                           Adults 18+, Monroe County, 2006
                       50

                       40
             Percent




                       30
                                  24                             African American
                                                                 White
                       20
                                             12
                       10
                                                             (N=2,545)
                       0
                                       18+

   African Americans are twice as likely to rate their health as fair or poor than
   whites.
Monroe County Adult Health Survey Report, 2006

                                                                    September 28, 2012   8
Health Status by Hispanic
Origin or Poor Reported Health Status by Age Group and Race –
     Fair
                              Adults 18+, Monroe County, 2006
                     50

                     40
           Percent




                     30         26
                                                               Latino
                                                               Non-Latino
                     20
                                            13
                     10
                                                            (N=2,545)
                     0
                                     18+
  Significantly fewer non-Latinos rate their health status as fair or poor than
  Latinos.
Monroe County Adult Health Survey Report, 2006

                                                                  September 28, 2012   9
                          Adult Health Insurance
                          Coverage – Monroe County
                                              Uninsured Adults Aged 18-64 Years Old       The majority of individuals
                                       25                                                 reported job-related reasons for
Percent Do Not Have Health Insurance




                                                                                          not having health insurance.
                                                                     20
                                       20                                                     Couldn’t afford premiums
                                                                                               (36%)
                                       15     14
                                                                                              Lost or changed jobs (22%)
                                                                                              Employer doesn’t offer or
                                       10
                                                                                 7             stopped offering coverage
                                                          5                                    (12%)
                                        5
                                                                                          According to recent studies,
                                        0                                                 insurance coverage reduces
                                             African    White       Latino   Non-Latino   disparities among low-income
                                            American                                      and minority adults




        Monroe County Adult Health Survey Report, 2006

                                                                                                  September 28, 2012         10
     Access to a Primary Care
     Provider                                                                        Could Not Afford Medical Care
                  Do Not Have a Health Care Provider                                        in the Past Year
      20                              18                                25
      18
                                                                                                         22




                                                              Percent
Percent




      16         15
                                                                        20
      14
      12                                                                15      13
      10
          8                                       7                     10                                             8
                            6                                                                7
          6
          4                                                             5
          2
          0                                                             0
               African    Whites    Latinos   Non-Latinos                     African      Whites      Latinos     Non-Latinos
              Americans                                                      Americans

                                                        (N=2,545)


                Lack of primary care provider and being unable to afford medical care in the
                last year were cited as the main barriers to accessing primary care. These
                mostly affected African Americans and Latinos.
     Monroe County Adult Health Survey Report, 2006

                                                                                              September 28, 2012                 11
     All PQI Hospitalizations –
     Discharges, 2006
                                                                  Patient Days – 597,787
                               All Discharges
                                                                   Charges (not costs) -
                                   106,801
                                                                     $1,628,488,166

                             PQI Discharges
                                   9,419
                            9% of all discharges




           Patient Days                              Charges (not costs)
              62,595                                   $133,494,396


               Beds
              171.89
                                                   In 2006, preventable hospitalizations
                                                   filled 172 beds and accounted for 9% of
                                                   all charges in Monroe County hospitals.
AHRQ Prevention Quality Measures, 2006
                                                               *Includes HH, RGH, Unity, SMH, Lakeside

                                                                           September 28, 2012            12
Probability of Hypertension
Among U.S. Women, 1999-2002
  1
0.9
0.8
0.7
0.6
                                                                               Whites
0.5
                                                                               Blacks
0.4
0.3
0.2
0.1
  0
 15

      19

           23

                 27

                      31

                            35

                                 39

                                      43

                                            47

                                                 51

                                                       55

                                                            59

                                                                 63
Geronimus et al. In Press. Black-White Differences in Age Trajectories of Hypertension
Prevalence Among Adult Women & Men, 1999-2002. Ethnicity and Disease.
Low Birth Weight Rates by
Maternal Education and Race
(Chicago, IL)

                   18
                   16
  %LBW (< 2500g)




                   14
                   12
                   10                                              African-American
                    8                                              White
                    6
                    4
                    2
                    0
                        < 12      12     13-15     16       > 16
                               Maternal education (years)
Connecting the Dots
Relationship between health status and
race/ethnicity
Relationship between perinatal health and lifetime
health
Birth Weight and Health
Outcomes
Babies born at less
than 5 pounds
• 2.5 times more likely to have            Probability decreases
  a stroke in adulthood                   with increasing weight
• 2 times more likely to                  – relative risk neutral or
  develop Type 2 Diabetes
                                           positive over 7 pounds
• 1.5 times more likely to
  develop hypertension



 Nurses’ Health Study   Curhan et al., Rich-Edwards et al.
   Birth weight and CVD Outcomes
   Nurses’ Health Study



                   2.5                               CHD
                                                     Stroke
                    2                                Hypertension
   Relative risk




                                                     Type 2 Diabetes
                   1.5

                    1

                   0.5

                    0
                     <5.0   5.0-5.5   5.6-7.0   7.1-8.5   8.6-10.0   >10.0
                                      Birthweight (lb)
Curhan et al., Rich-Edwards et al.
LBW:            Cause and Consequence


                    Low Birth
• Diabetes           Weight
• Hypertension/Ca                   • In utero
  rdiovascular      • Prematurity     adaptations
  Disease           • Gene/         • Next-generation
                      environment
• Inflammatory
  Disease             interaction        Chronic
     Chronic                             Disease
     Disease
Adverse childhood events and
adult ischemic heart disease
             3.5

              3
                                               0
             2.5
                                               1
Odds Ratio




              2                                2
                                               3
             1.5                               4
                                               5,6
              1
                                               7,8
             0.5

              0


                   Adverse Events   Dong et al, 2004
Connecting the Dots
Relationship between health status and race/ethnicity
Relationship between perinatal health and lifetime
health
Relationship between health conditions and causes
Is There a Common Link?

 Contributors to
   Diabetes
   Hypertension/Cardiovascular Disease
   Inflammatory Disease and Infection
   Low Birth Weight
The common theme:                      Stress

                     Elevated blood
                        pressure




     Elevated
  glucocorticoids       Stress          Elevated glucose




                     Neuroendocrine
                    and inflammatory
                        response
Physiological Impact of
Stress
          Stressed                   Stressed Out
• Increased cardiac output   • Hypertension &
                             cardiovascular diseases
• Increased available
Glucose                      • Glucose intolerance &
                             insulin resistance
• Enhanced immune
Functions                    • Infection & inflammation

• Growth of neurons in       • Atrophy & death of
hippocampus &                neurons in hippocampus
prefrontal cortex            & prefrontal cortex
Epigenetics




Scientific American 2003
Connecting the Dots
The Source of the Stress
Carnage of Racism
  Racism and Stress


Institutional
Housing segregation
Education segregation
Job discrimination
Access to health care
Arrest and incarceration rates
  Racism and Stress

Individualin
Housing, banking and employment
Racial profiling by police
Harsher sentencing for minority defendants
Lower educational expectations for minority
students
Unequal medical treatment
National Community
Reinvestment Coalition Study
 Brokers spent 39 minutes with white testers, 27
  minutes with African American and Latino testers.
 African Americans and Latinos were questioned about
  their credit over 32% of the time; white shoppers 13%
  of the time.
 White testers received two rate quotes for every one
  quoted to African American and Latino testers.
 Fees were discussed 62% of the time with white
  testers 35% of the time with “protected testers.”
 Fixed rate loans were discussed 77% of the time with
  white testers, 50% of the time with African American
  and Latino testers.
Study conducted in 2007
MATERNAL CHRONIC EXPOSURE TO INTERPERSONAL
RACISM IN THE WORKPLACE AND INFANT BIRTH WEIGHT


                       50
                       45
 % exposed to racism




                       40
                       35
                       30
                                                                               VLBW
                       25
                                                                               non-LBW
                       20
                       15
                       10
                        5
                        0
                            1 or more*         3 or more*          7 or more
                                         Racist Events-Workplace
 Racism and Stress


Internalized
• self doubts
  • lower school performance
  • depressive symptoms
  • substance abuse
  • dropouts
  • other risk behaviors
Connecting the Dots
From the Past to the Future
Traditional Efforts

       Birth           Childhood
                                     Adult Disease
     Outcomes           Disease
   • Early           • Disease-      • Disease-
     prenatal care     specific        specific
   • Monitor           information     information
     birth           • Symptom       • Symptom
                       diagnosis       diagnosis
                       and             and
                       treatment       treatment
The New Paradigm

         Pregnancy

    Adulthood      Infancy

          Childhood
Health as a Developmental
Process
    • Biology                               • Biology
    • Environment                           • Environment
    • Behavior                              • Behavior


                    Pregnancy    Infancy




                    Adulthood   Childhood

   • Biology                                • Biology
   • Environment                            • Environment
   • Behavior                               • Behavior
Life Course Health
Development
                        Poor Nutrition                White
                        Stress
                        Abuse
                        Tobacco, Alcohol, Drugs
                        Poverty
                        Lack of Access to Health Care
                        Exposure to Toxins




                                                     African
                                                    American
                    Poor Birth Outcome

Age   0   5   Puberty                  Pregnancy
The Conversation Has Begun

 PNMC and FLHSA partnership
 Racial Disparities in Health: A Life Course
  Perspective
 Actionable Ideas
   Nearly 100 participants
   Open discussion of the impact of race
   Over 20 projects – concrete, actionable steps
A Community Action Plan
   • Public Policy
   • Community Capacity Building
   • Neighborhood Health

  Only the Beginning
  • Related projects
  • New initiatives
What is Your Role?

“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:7
posted:9/28/2012
language:English
pages:40