HEALTH DISPARITIES IMPACTING RACIAL AND ETHNIC MINORITIES IN MICHIGAN
CONTRIBUTORS:
BUREAU OF EPIDEMIOLOGY BUREAU OF FAMILY, MATERNAL, AND CHILD HEALTH DIVISION OF CHRONIC DISEASE AND INJURY CONTROL DIVISION OF HEALTH, WELLNESS AND DISEASE CONTROL
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Purpose of Health Disparities Initiatives
To increase awareness of health disparities by collecting and disseminating relevant data
Decrease the burden of disparities by distributing information on public health interventions with proven effectiveness Establish a systematic approach to collaboration and communication among governmental, private and community based health entities Leverage resources to initiate new and innovative programs
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Elimination of Health Disparities
Became significant concern in 1998 Six health categories: adult immunization, cardiovascular care, cancer care, diabetes, HIV/AIDS and infant mortality
“The test of progress is not whether we add more to the abundance of those who have much, it is whether we provide enough for those who have little”
Franklin Delano Roosevelt
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What is a Health Disparity?
Health: A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (World Health Organization) Disparity: A chain of events signified by a difference in (1) environment; (2) access to, utilization of, and quality of care; (3) health status; or (4) a particular health outcome that deserves scrutiny.
Carter-Pokras & Baquet, Public Health Reports, Sept/Oct, 2002 4
Health Disparities
Disparities in health, which refer to differences in health outcomes and status; and Disparities in health care, which refer to differences in the preventative, diagnostic and treatment services offered to people with similar health conditions, as well as, health care access.
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Contributing Factors
Poverty Education Level Cultural Attitudes, Norms, and Values Minority Mistrust of Healthcare System Language
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Contributing Factors (cont.)
Provider Cultural Competency “Health is really a social transaction that has a scientific base. You need to have doctors who have the basic knowledge, but that alone is not enough. You have to have a physician that is able to communicate in a way a patient understands.”
Dr. Louis Sullivan, former U.S. Secretary of Health and Human Services
Stereotypes held by Healthcare Providers Access to Health Care
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Contributing Factors (Continued)
ACCESS to Health Care
45.8 million Americans (15.7% of the total population) lacked health insurance in 2005.
•
Minorities are more likely than whites to be uninsured
32.7% of Hispanics are uninsured 29.9% of Native Americans and Alaska Natives are uninsured 19.6% of African-Americans are uninsured 17.9% of Asians are uninsured 11.3% of white non-Hispanics are uninsured
7.8% of Michigan residents, or almost 800,000 people are uninsured at any one time.
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State Planning Project for the Uninsured 2005; U.S. Census Bureau 2005
“The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadows of life, the sick, the needy and the handicapped”
Hubert H. Humphrey
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Disparities Across the Spectrum
Infant Mortality Prostate Cancer
HIV/AIDS
The rate of HIV Black infant infection among Black male deaths occur Blacks is over 8 deaths occur almost 3 times times higher 2 times more more often than often than White than the rate White infant among Whites male deaths deaths
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Demographic Profile
Distribution of Michigan's Population by Race/Ancestry
Race/Ancestry White Black American Indian Asian/Pacific Islander/ Other 1980 1990 2000 2005 % Change
85.8 84.2 80.2 13.0 14.0 14.2 0.5 0.6 0.6
80.0 14.0 0.6
-6.8 7.7 20.0
0.7
1.2
3.1
3.8 1.6 3.8
442.9 N.A. 123.5
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Multi-Racial Hispanic
N.A. N.A. 1.9 1.7 2.2 3.3
Michigan Life Expectancy
1950
82 77 72 67 62 57 52
2005
82 77
71.9 75.8 80.1 75.1
72
68.0
66.2 63.4 60.4
67 62 57 52
White males
White females
Black males
Black females
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Survival Curve Ages 15-75 by Sex and Race, Michigan Residents, 2005
100 90 80 70 60 50 40 30 20 10 0
Percent Survival
Percent Surviving to 65 (2003):
White Female 88.0
Black Female 76.9
White Male
Black Male
81.5
63.4
15 20 25 30 35 40 45 50 55 60 65 70 75 13 Age
Racial and Gender Disparities in Selected Risk Factors for Chronic Disease, Michigan, 2005
45 40 35 30 25 20 15 10 5 0 HBP 36.3 38.7 34 27.426.6 27.5 21.2 22.319.6 10.3 12.5 8.3 7 32.9 26.6 24.2
Diabetes
Smoking
Obesity
Black Males
Black Females
White Males
White Females
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Source: Michigan Behavior Risk Factor Surveillance System
Cancer
A diverse group of diseases characterized by uncontrolled growth and spread of abnormal cells
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Breast Cancer Incidence and Mortality by Race
140
Age-adjusted rate per 100,000*
120 100 80 60 40 20 0
123.3 113.2
Black White 32.9 23.7
Incidence 2003
*Adjusted to 2000 US standard population.
Mortality 2003
16 Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
Cervical Cancer Incidence and Mortality by Race
14 12 10 8 6 4 2 0 Incidence 2003
*Adjusted to 2000 US standard population.
Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
11.7
6.6 3.1 1.7
Black White
Mortality 2003
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Colorectal Cancer Incidence and Mortality by Race
60
Age-adjusted rate per 100,000*
55.7 44.9 Black White 15.2
50 40 30 20 10 0
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Incidence 2003
*Adjusted to 2000 US standard population.
Mortality 2003
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Lung Cancer Incidence and Mortality by Race
100 90 80 70 60 50 40 30 20 10 0 94.5 72.8
68 54.9 Black White
Incidence 2003
*Adjusted to 2000 US standard population.
Mortality 2003
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Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
Prostate Cancer Incidence and Mortality by Race
300 250 200 150 100 50 0 Incidence 2003
*Adjusted to 2000 US standard population.
273.8
159.5
Black White
44.7 23.6 Mortality 2003
20 Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
Cardiovascular Disease
Any disease that affects the heart or blood vessels by restricting the flow of blood.
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140 120
Age-Adjusted Stroke Death Rates by Race Michigan Residents, 1980-2005
Per 100,000 Population
100 80 60 40 20 0
White Black
19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96 19 98 20 00 20 02 20 04
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Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
19 80
Age-Adjusted Heart Disease Death Rates by Race Michigan Residents, 1980-2005
600
500
Per 100,000 Population
400
300
200
100
White Black
19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96 19 98 20 00 20 02 20 04
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0
Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
19 80
Diabetes
A chronic disease characterized by the inability to use the glucose in food for energy.
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Prevalence of Diabetes by Race/Ethnicity, Michigan & U.S.
Race/Ancestry White Black Hispanic Other Multi-Racial US 2005 6.8% 11.4% 6.6% 7.2% 8.3% MI 2005 7.6% 12.0% 8.5% 5.0% 9.6%
Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005. 002 data; CDC. (2004) National Diabetes Fact Sheet ; Diabetes 25 Care, July, 2003
Deaths Due to Diabetes per 100K
Death
White - Primary Cause Black - Primary Cause White - Any Mention Black – Any Mention
U.S. 2003
23.0
MI 2003
24.2
MI 2005
24.7
49.2
N.A. N.A.
38.4
74.9 116.8
40.0
76.3 124.5
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HIV/AIDS
HIV: Human Immunodeficiency Virus
Transmission: Unprotected Anal/Vaginal/Oral Sex Needle Sharing Maternal AIDS: Acquired Immune Deficiency Syndrome
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Prevalence Estimates of Persons Living with HIV/AIDS in MI by Sex and Race as of October 1, 2006
7000
Prevalence Estimate
6000 5000 4000 3000 2000 1000
Hispanic males Hispanic females
0
Black males White males Black females White females
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HIV Related Deaths in MI, all ages, by Race & Sex, 1990-2005*
500 450 400 350 300 250 200 150 100 50 0
Number of Deaths
*Deaths for 2005 may be incomplete.
19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 *
Year of Death
White Males White Females
Black Males Black Females
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Infant Mortality
The number of deaths occurring in children under the age of one year.
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Race specific Infant Mortality Rate Michigan compared to US
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Black MI White MI
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Black US White US
Per 1,000 live births
15
10
5
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
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Source: Vital Records & Health Data Development Section, Michigan Department of Community Health
Eliminating Disparities
“We cannot become what we need to be by remaining what we are” Max Depree
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General Recommendations
New knowledge about the determinants of disease Develop infrastructure capacity of community-based organizations Programs must emphasize behavioral risk-reduction and other prevention strategies
Communities must assist at-risk individuals in accessing programs designed to diagnose and treat conditions early
Greater role of local leaders including faith-based and fraternal organizations Community level interventions to promote normative change Evidence-based strategies
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General Recommendations (Cont.)
Public Health safety net Integration of healthcare services, one stop shopping Development of comprehensive community health centers Comprehensive health screening programs for communities of color
Culturally and gender appropriate skills-building workshops Mobile Outreach
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Specific Groups Recommendations
1.
Schools (K-12): Add prevention messages to MI Model for Comprehensive School Health Education Curriculum. Urge the adoption of policies on healthy foods and beverages. Higher Education: Increase number of ethnically diverse/culturally competent providers
(Michigan Diabetes Strategic Plan recommendations, 2003)
2.
3.
Business: Create work-based risk-reduction, screening, self-management education among employer/union groups Healthcare: Support programs that serve minority populations; Promote culturally acceptable prevention disease management
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4.
Specific Groups Recommendations (Cont.)
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Healthcare Organizations: Partner with professional organizations to improve awareness, knowledge and skills among health care providers Community Organizations: Promote messages and use of lay health workers among faith-based and other community organizations State Government: Target funding to reduce health disparities (Michigan Diabetes Strategic Plan recommendations, 2003)
Media’s Role: Implement statewide public awareness campaign of health disparities
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6.
7.
8.
Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
Martin Luther King Jr.
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Health Disparities Work Group
Audrea M. Woodruff, Chairperson Acting Manager, HDRMH
Fawzie Ahmed Rhonda Bantsimba Brandon Boyle Patricia Brookover Alethia Carr Jean C. Chabut Robert Cochran Arthur Davis Daniel Diepenhorst Paulette Dobynes Dunbar Konrad Edwards
Sheila Embry Sophia Hines Jacquetta Hinton Erma Leaphart-Gouch Henry Miller Amy Slonim Debra Szwejda Jada Williams
Dr. Kimberlydawn Wisdom, Surgeon General
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