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Health Disparities in Arizona

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					Health Disparities
   in Arizona

 Zipatly Mendoza, Arizona Health Disparities Center
Janey Pearl, ADHS PIO, Human Relations Commission
    RJ Shannon, ADHS HIV/STD/Hep C Program


            Arizona Health Disparities Center
               www.azminorityhealth.gov
Health Disparities…

•   What   are they?
•   What   do they look like for us?
•   What   causes them?
•   What   are we doing about it?




               Arizona Health Disparities Center
                       www.azminorityhealth.gov
Is it fair that…
•      Poor people die younger than rich
       people?
•      Lower social class infants have lower
       birth weight outcomes?
•      Working poor are not able to afford
       health insurance?
•      Minority groups repeatedly score
       worse on various health rankings?

    Source: Measuring Health Disparities; Center for Social Epidemiology and Population; University of Michigan, 2003.



                                      Arizona Health Disparities Center
                                                 www.azminorityhealth.gov
Health Disparities
Differences in health outcomes exist
among specific population groups
         • Occurrence of disease
         • Number of cases of disease
         • Burden of disease
         • Death rates



Source: National Institutes of Health (NIH) Strategic Plan to Reduce and Ultimately Eliminate Health Disparities, 2001.



                                    Arizona Health Disparities Center
                                               www.azminorityhealth.gov
  Arizona Population by Race and Ethnicity
                                      5%
                                             2%
                                                  3%

                                                            Total Population: 6,044,985
                                                                             Native American
                                                                             Asian
                                                             25%             Black
                                                                             Hispanic
                                                                             White

           65%




Source: Differences in the Health Status Among Race/Ethnic Groups, Arizona 2005. Bureau of Public Health
Statistics, ADHS.


                                  Arizona Health Disparities Center
                                           www.azminorityhealth.gov
Arizona Tribal Nations
                                        12.      Pascua Yaqui
1.  Ak-Chin
                                        13.      Quechan
2. Cocopah
                                        14.      Salt River
3. Colorado River Indian
    Tribe                               15.      San Carlos
4. Ft. McDowell                         16.      San Juan Southern
                                                 Paiute
5. Ft. Mojave
6. Gila River
                                        17.      Tohono O’odham
                                        18.      Tonto Apache
7. Havasupai
                                        19.      White Mountain
8. Hopi
                                                 Apache
9. Hualapai
                                        20.      Yavapai Apache
10. Kaibab Paiute
                                        21.      Yavapai Prescott
11. Navajo Nation
                                        22.      Zuni
              Arizona Health Disparities Center
                      www.azminorityhealth.gov
Languages Spoken at Home
Asian & Pacific Island   1.5%

      Indo-European      2.1%

                Other      2.5%

              Spanish                21.9%

              English                                                 72.0%

                      0%          20%          40%              60%    80%    100%



           Source: 2006 American Community Survey, US Census Bureau.



                             Arizona Health Disparities Center
                                     www.azminorityhealth.gov
Who do health disparities affect?

•   Us!
    *Arizona Communities
      • Businesses, schools, churches, etc.
    *Health care systems
      • Hospitals, clinics, insurance co., etc.
    *Arizona Economy
      • Prevention vs. cost of treatment


                Arizona Health Disparities Center
                        www.azminorityhealth.gov
Why do health disparities exist?

 •   Social Determinants of Health
 •   Systems of Care
 •   Historical Factors




              Arizona Health Disparities Center
                      www.azminorityhealth.gov
 What are Social Determinants?
Community conditions that have an effect on a person’s health

 •   Early childhood care
         • Proper development is crucial during early years

 •   Education
         • Low income schools often lack resources

 •   Food security
         • Access to healthy, nutritional food

 •   Housing
         • Access to safe housing, free from harmful substances


                      Arizona Health Disparities Center
                              www.azminorityhealth.gov
    Social Determinants (cont.)
•   Income inequality
        • More higher incomes, higher poverty rates  bigger gap

•   Social inclusion and exclusion
         • Geographical differences between classes  resources

•   Employment and job security
        • High unemployment, More part-time employees  lack of
          insurance/benefits

•   Working conditions
        • Hazards, environment, stress




                      Arizona Health Disparities Center
                              www.azminorityhealth.gov
Social Determinants of Health
                       RACE/ETHNICITY        EDUCATION
                                                             LIVING
                                                             CONDITIONS

            POVERTY                   DISABILITY
        ACCESS TO
                                                                       INCOME
        CARE


                                                                          CULTURAL
                    DISEASE          DISPARITIES       PREMATURE          PRACTICES
                                                       DEATH
   VIOLENCE
      ENVIRONMENT
                                                                    SEXUAL
     COMMUNITY                        POOR HEALTH                   ORIENTATION
                                      OUTCOMES
          GEOGRAPHIC                                                AGE
          LOCATION
                       RURAL/URBAN                     WORKING
                       STATUS                          CONDITIONS
                                      GENDER




                       Arizona Health Disparities Center
                                www.azminorityhealth.gov
What are we talking about?
Meet Jason.
He is currently in the hospital.

Why is Jason in the hospital?
Because he has a bad infection in his leg.
But why does he have an infection?
Because he has a cut on his leg and it got infected.
But why does he have a cut on his leg?
Because he was playing in the junk yard next to his
apartment building where there was some sharp, jagged
steel that he fell on.
But why was he playing in a junk yard?



                  Arizona Health Disparities Center
                          www.azminorityhealth.gov
Because in his neighborhood there is nowhere
else for kids to play, and parents are at work
so there is no one to supervise them.

But why does he live in that neighborhood?
Because his parents can't afford another place to live.
But why can't his parents afford another place to
live?
Because his Dad doesn’t make much money and his
Mom is sick.
But why doesn’t his Dad make much money?
Because he doesn’t have much education, and hasn’t
been able to find another job.

But why ...?
       Source: ‘Toward a Healthy Future: Second Report on the Health of Canadians’. Found on: http://www.phac-
                           aspc.gc.ca/ph-sp/phdd/determinants/index.html#determinants


                           Arizona Health Disparities Center
                                       www.azminorityhealth.gov
Systems of care




        Arizona Health Disparities Center
                www.azminorityhealth.gov
"Health inequalities are produced by
  the clustering of disadvantage - in
  opportunity, material circumstance,
  and behaviors related to health
  across people's lives."
Shaw M., Darling D., Gordon D. and Davey Smith G. (1999). The Widening Gap: Health Inequalities and Policy in Britain. Bristol: The Policy Press.




                                                 Arizona Health Disparities Center
                                                              www.azminorityhealth.gov
History
•    Discrimination
        • Barriers
        • Trust


•    Cultural/Family norms
        • Cultural beliefs
        • Communication within families

              Your genes load the gun…
    ….but your lifestyle pulls the trigger!
                              -Grant Jones



                     Arizona Health Disparities Center
                             www.azminorityhealth.gov
                         Health Rankings
                   Number of Times Each Group Ranked Better Than
                     Average, Average, and Worse Than Average
                           on 70 Indicators, Arizona, 2005


          Asian                           56                        5     9
                                                                                               Better than average

       White
    non-Hispanic
                                   46                         9         15                    Average


                                                                                               Worse than average
        Hispanic         18                 27                     25


American Indian          15          16                     39


African American     8        14                         48

               Source: Differences in the Health Status by Race/Ethnic Groups. Bureau of Public Health Statistics, ADHS 2005


                                         Arizona Health Disparities Center
                                                      www.azminorityhealth.gov
Top 5 Causes of Death in AZ
1. Diseases of the Heart
2. Cancer
3. Accidents (Unintentional injury)
4. Chronic lower respiratory diseases
5. Stroke, Alzheimer's, Dementia
  (Cerebrovascular)



           Arizona Health Disparities Center
                   www.azminorityhealth.gov
Top 5 Causes of Death by
       Ethnicity
       Mortality Rates for the Five Leading Causes of Death for
                   Both Genders by Race/Ethnicity


                Asian or           American          Black or African        Hispanic or     White non-
Rank             Pacific           Indian or            American               Latino         Hispanic
                Islander         Alaska Native

               Diseases of         Diseases of          Diseases of          Diseases of     Diseases of
 1                heart               heart                heart                heart           heart
                  94.7                129.4                231.9                149.8           168.8

                 Cancer          Unintentional            Cancer               Cancer          Cancer
 2                82.0              injury                163.5                124.7           162.8
                                     97.2
              Unintentional          Cancer               Stroke            Unintentional   Chronic lower
 3               injury               83.1                 58.2                injury        respiratory
                  19.8                                                          52.4        diseases 49.2

               Influenza &          Diabetes          Unintentional           Diabetes      Unintentional
 4             pneumonia              43.9                injury                40.4           injury
                    21.7                                   54.8                                 48.7

                                  Chronic liver                                              Alzheimer's
 5               Stroke           disease and            Diabetes              Stroke          disease
                  18.4              cirrhosis              43.9                 37.3             34.7
                                       43.6

       *Number of deaths per 100,000 population age-adjusted to the 2000 U.S. standard.

                          Arizona Health Disparities Center
                                    www.azminorityhealth.gov
This is a social
justice issue !
Cardiovascular Disease
  American Indian                                                    235.6


White non-Hispanic                                                     241.3


              Asian                                                      243


    ALL GROUPS                                                         245.7


          Hispanic                                                           266.1


              Black                                                                          343.3


                        0         50         100        150        200         250        300        350


              Number of deaths per 100,000 population (age-adjusted to the 2000 standard)


        Source: Differences in the Health Status by Race/Ethnic Groups. Bureau of Public Health Statistics, ADHS 2005


                                     Arizona Health Disparities Center
                                                   www.azminorityhealth.gov
Cancer
             Asian                                  112.7



  American Indian                                     122.2



    ALL GROUPS                                                     161.8



White non-Hispanic                                                  162.4



          Hispanic                                                   165.9



             Black                                                                   217.9


                      0              50             100             150             200             250


              Number of deaths per 100,000 population (age-adjusted to the 2000 standard)

          Source: Differences in the Health Status by Race/Ethnic Groups. Bureau of Public Health Statistics, ADHS 2005


                                          Arizona Health Disparities Center
                                                     www.azminorityhealth.gov
Cervical Cancer
              Black                       1.4



White non-Hispanic                               1.8



    ALL GROUPS                                         2.1



  American Indian                                                         3.4



          Hispanic                                                                    4.1



              Asian                                                                         4.6


                       0      0.5     1         1.5      2     2.5    3         3.5     4    4.5     5

                      Number of deaths per 100,000 population (age-adjusted to the 2000 standard)

     Source: Differences in the Health Status by Race/Ethnic Groups. Bureau of Public Health Statistics, ADHS 2005


                                      Arizona Health Disparities Center
                                                       www.azminorityhealth.gov
Colorectal Cancer
  American Indian                       7.5



              Asian                               12.5



White non-Hispanic                                       15.2



    ALL GROUPS                                           15.4



           Hispanc                                              17.6



              Black                                                                       27


                      0             5           10           15            20           25           30

               Number of deaths per 100,000 population (age-adjusted to the 2000 standard)

        Source: Differences in the Health Status by Race/Ethnic Groups. Bureau of Public Health Statistics, ADHS 2005


                                          Arizona Health Disparities Center
                                                      www.azminorityhealth.gov
Rates of HIV/AIDS
                 Asian           6.9



 White non-Hispanic                    10.1



     ALL GROUPS                           12.8



   American Indian                             15.1



             Hispanic                             16



                 Black                                                                        41.6


                         0        5       10          15    20       25       30       35       40       45

              Number of reported cases per 100,000 (age-adjusted to the 2000 standard)
   Source: Differences in the Health Status by Race/Ethnic Groups. Bureau of Public Health Statistics, ADHS 2005


                                   Arizona Health Disparities Center
                                                 www.azminorityhealth.gov
Rates of Early Syphilis
                Asian          2.6



 White non-Hispanic             2.9



     ALL GROUPS                           5.1



            Hispanic                                    8.6



   American Indian                                              10.6



                Black                                                                   16.5


                        0       2        4       6        8      10       12      14       16      18

               Number of reported cases per 100,000 (age-adjusted to the 2000 standard)
   Source: Differences in the Health Status by Race/Ethnic Groups. Bureau of Public Health Statistics, ADHS 2005


                                     Arizona Health Disparities Center
                                                www.azminorityhealth.gov
Rates of Gonorrhea
              Asian        14.6



White non-Hispanic      31.5



    ALL GROUPS                    81.9



          Hispanic                   95



  American Indian                         142.6



              Black                                                                     395.7


                       0       50        100      150     200      250      300      350      400      450

                  Number of reported cases per 100,000 (age-adjusted to the 2000 standard)
      Source: Differences in the Health Status by Race/Ethnic Groups. Bureau of Public Health Statistics, ADHS 2005


                                      Arizona Health Disparities Center
                                                   www.azminorityhealth.gov
Rates of Chlamydia
                Asian        99.7



 White non-Hispanic          121.9



     ALL GROUPS                                      352



            Hispanic                                         468.5



                Black                                                                    778.1



   American Indian                                                                            827.6


                         0       100      200      300      400      500      600       700      800      900

                 Number of reported cases per 100,000 (age-adjusted to the 2000 standard)
      Source: Differences in the Health Status by Race/Ethnic Groups. Bureau of Public Health Statistics, ADHS 2005


                                     Arizona Health Disparities Center
                                                 www.azminorityhealth.gov
What has to happen
•   Systems level changes
•   Coordination and leverage of resources
    and assets
•   Enhanced research
•   Interdisciplinary approaches to research,
    program implementation and
    campaigning
•   Cultural Competency
•   Health Literacy

               Arizona Health Disparities Center
                       www.azminorityhealth.gov
What else has to happen
•   Education about health disparities
•   Organization of campaign and
    outreach events
•   Share best practices and lessons
    learned
•   Collaborate! Collaborate!! Collaborate!!!




                Arizona Health Disparities Center
                        www.azminorityhealth.gov
    Health Equity
•   All individuals have the opportunity to
    achieve full potential through
    healthcare and disease prevention
      Fairness in health distribution, information,
        access to care, etc.




Source: National Institutes of Health (NIH) Strategic Plan to Reduce and Ultimately Eliminate Health Disparities, 2001.




                                      Arizona Health Disparities Center
                                                 www.azminorityhealth.gov
Systems of care




        Arizona Health Disparities Center
                www.azminorityhealth.gov
What YOU can do…

•   Pay attention to your health
•   Get screened
•   Seek out!
•   Speak out!
•   Help out!


              Arizona Health Disparities Center
                      www.azminorityhealth.gov
Next Faces of Diversity Brown Bag Lunch Series:

                  Noon to 1 p.m.

                Friday, July 25

       Phoenix City Council Chambers
             200 W. Jefferson St.

                       Join Us!




             Arizona Health Disparities Center
                     www.azminorityhealth.gov
For More Information:
          Zipatly Mendoza
         Mendozz@azdhs.gov

             Janey Pearl
           Pearlj@azdhs.gov

            RJ Shannon
         Shannor@azdhs.gov

Arizona Department of Health Services
           www.azdhs.gov
  Arizona Health Disparities Center
      www.azminorityhealth.gov


        Arizona Health Disparities Center
                www.azminorityhealth.gov

				
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