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Category: Week 6 – Health Disparities & Unconscious Bias

Mortality and Minorities

Mortality and Minorities

Hi, my name is Morgan Hill and I have no idea what a health disparity is, and the SEM confuses me. If you are in the same boat I was before I wrote this post, this may be the post for you.

So, first off, what the heck is a health disparity? It is basically the difference in the health of different groups. The groups could be based on race, ethnicity, economic status, gender, sexual orientation, etc. Some examples of health disparities are: minorities are more susceptible to heart disease and women are more susceptible to breast cancer. Of course, there are hundreds of other health disparities.

What is the SEM, and what could it possibly have to do with health disparities? SEM stands for social- ecological model, and consists of 5 different levels. These levels include:

  1. intrapersonal factors (individual characteristics)
  2. interpersonal factors (people around you who may influence you)
  3. organizational factors (organizations that promote behaviors)
  4. community factors (community norms)
  5. public policy (laws that regulate behaviors)

These levels can all contribute to how at-risk an individual/ group is to medical conditions which creates and continues health disparities.

Hopefully you understand health disparities and SEM a little better, now let’s put our knowledge to the test.

According to the CDC, infant mortality is higher in black children than any other race. Compared to white babies, black babies are almost three times more likely to die in its first year of life. This is a very shocking health disparity that really makes me think, what could possibly contribute to such a large difference in the death of babies. So, let’s think of this in terms of the SEM. On an intrapersonal level, black women have less knowledge about what exactly contributes to infant mortality and what a healthy pregnancy consists of, which includes eating healthy, exercise, and vitamins. This means, black women are less likely to make healthy choices like eating healthy and exercising during pregnancy. On an interpersonal level, black women are more likely to live in stressful environments which contributes to infant mortality. There is even a study which proves that black women are more prone to stress because of the racism that blacks are subjected to. On an organizational level, black women have less exposure to healthy food and vitamins, as well as good health care insurance. On a community level, there could be different beliefs about what a healthy pregnancy really means. Finally, on a public policy level, there are no laws that regulate the health of pregnant women.

The greatest intervention that could really help black women would be to educate them on this specific health disparity and ways to have a healthy pregnancy, which impacts the intrapersonal level. This could lead to black women eating healthier, exercising, taking vitamins, and eliminating stress during their pregnancies.      

As I stated above, racism has had an impact on the stress levels of black women which contributes to infant mortality. Do you know of any other specific examples where racism has affected the health of a racial group, other than the quality of a doctor’s work?

Hopefully, my little blog post helped you understand health disparities and the SEM. Let me know you feel about the above health disparity, and if this post helped you understand this week’s topic. 

Thanks for reading!

Health Disparities

Health Disparities

In the world, there is a large population that smokes. And in today’s world, we try to make it clear that they are bad and have really devastating side effects. A majority of races, ethnicities, and populations all have people who smoke in some sort of way. Whether it be whites, blacks, Hispanics or other, they all smoke. Why is that? It can be used to relieve stress, some it is a pass time, or maybe they started at a young age to be cool and never dropped the habit. Smoking is a disparity that affects many people. A disparity is a thing that affects many people of a certain group of people, like race, socioeconomic status, and much more. In the Hispanic community, about 21 percent use some sort of tobacco daily. By smoking, it can lead them to have many bad diseases and possibly die. There are many influences on why a large chunk of the Hispanic community smokes. And the Social-Ecological Model can help me explain it.

The Social-Ecological Model is a model that shows influences that can affect people and their health. The model has many levels starting at individual, and going to as large as public policy. I will show you the levels of individual, relationship, and community influences of the Social-Ecological Model (SEM). Let us say we are talking about a small community where the majority of the population is Hispanic. Individually, not many of the population understands what is bad about smoking. The reason for this might be that some of the population that smokes are older who really do not understand English. Since they do not speak English, it is harder for them to get the information from doctors and such. On the relationship aspect, many young members of the smoking population have been around the older smoking population. Being young, they might think that it is cool and of course start to do it themselves. Also having peers who smoke does not really help either. With people around them smoking, many of the young population will start to smoke. On a community level, many stores and places that sell tobacco products know they cannot sell to minors. However, minors will have older people buy it for them. While of course this is illegal, some of the store clerks can be oblivious to what is happening before them. On the streets, you see people hanging out and smoking in many places. This was just a very simple example of how the SEM is used to help explain the influences that affect the smoking Hispanic community.

An intervention that could impact at least one of the levels could be start making flyers and papers that show the effects of smoking in Spanish so the older population can read it and actually see the effects. I know they have some in Spanish about drug use and their side-effects, but those are mostly directed to the younger population and talk about all types of drugs. I think making one that is directed to an older audience in Spanish will help a lot of the community and individual level.

Down Syndrome and Health Disparities

Down Syndrome and Health Disparities

The first time I had started to think about the disparities in health was back in 8th grade. My uncle Philip, who lives with my family, had just suffered a stroke that would eventually leave him paralyzed on one side of his body but my family and I didn’t know that at the time. Anyways, after the stroke, even though he was paralyzed, the doctors were completely hopeful that he would regain use of the right side of his body because it was not as severe as many other cases that they had seen make full recoveries. Following the stroke, my family had no other option but to place him in a nursing home that we would later find out was not working as hard as they should have been during his physical therapy. The physical therapy he was receiving wasn’t aggressive enough to make any progress because none of the therapists knew how to deal with someone who did not talk and could not understand them. He seemed to be getting worse, not better. Consequently, Philip did not receive the care he needed and we removed him from the nursing home. We brought him home and he’s been back with us since. I have always wondered if maybe we could have afforded a better nursing home, he would have received more attentive physical therapists and would be walking today? Or maybe if we had been able to pay for a private physical therapists to care for him, he’d at least be able to use his right arm? But those questions did not bother me that much because the real question on my mind was, if he didn’t have down syndrome would he be paralyzed today? If he could communicate like your average person, would the nursing home have been able to provide him with the care he needed? There is no confirming my speculations, but learning about health disparity in class reminded me of these questions that raced my mind when I was 14 years old before I even knew what health disparity was.

People with down syndrome have a shorter life expectancy than the rest of the general population. Even though kids with down syndrome are prone to many other life altering complications with their health, (including heart defects, leukemia, and dementia) I feel like their life expectancy could be related to the SEM Model. In 1997, a study showed that the life expectancy of white individuals with down syndrome was 50, while for blacks and other races it was 25 and younger. This is alarming in itself and that’s why it made me wonder if social and economic status played a part in the life expectancy of people with down syndrome. Caring for someone with down syndrome can be very expensive in the long run. If a family has more money to put towards a child with down syndrome does that child end up better off than a family who doesn’t? There is a shortage of health care professionals that are trained and willing to care for patients with intellectual disabilities. Thus, people with down syndrome may receive less routine preventive care services such as screenings and even just regular check ups. However, if a family has more time, money, and resources to put towards the care of someone with downs, does their life expectancy increase? This is just speculation on my part but I say yes all of these factors play a role in life expectancy. On the relationship level, if there is someone to spend an adequate amount of time with a child with downs they may be better taken care of which could play a huge role in their life expectancies. It is important for them to be surrounded by love and kinship so if that is absent, it could take a huge toll on health. On the community level, the institutions and programs set up for them could play a role in their health as well. People with downs are more likely to be overweight and this could lead to many other health issues. However, if there were more activities set up for them on the community level, would that obesity level decrease? For some, including my uncle, the only actual physical activity they could participate in was the special olympics every once in a while. That is not nearly enough to live a healthy life. On the societal level, could there be more done towards finding a way to keep the life expectancy of people with downs going up? Like maybe, creating even more awareness about the health risks that come with having down syndrome. Most people do not understand that by just having down syndrome, a person is way more susceptible to many diseases. When society thinks of down syndrome, they think of the mental disability part. However, it is not rare to have a kid with down syndrome battle leukemia or have a weak heart as my uncle does.

I can definitely say that progress has been made because today an individual with down syndrome is expected to live well into their 60s and 70s! (My uncle will turn 59 in February!!) I feel like at this point I am rambling so just to wrap up, do you guys think that the SEM model and what we learned about health disparities can relate to down syndrome and other disabilities that aren’t really preventative? Down syndrome may not be preventative but some of the things that comes with down syndrome could be prevented in my opinion.

Health Disparities: The Ignorant and the Blind

Health Disparities: The Ignorant and the Blind

The inequity between health outcomes among different racial groups in health care settings is a disgusting dark side to what is typically portrayed as an upstanding pillar of society. The bias and prejudice which exists in the health care field is not only palpable, but measurable. The public is predominantly ignorant of the statistics and data which highlight the vast disparities in quality of care and overall outcome of health facility visits among these diverse groups. Others dismiss the claim that there exists institutionalized racism in our health care system, and disregard the studies as misguided or unfounded. To truly establish equal health outcomes following care and create an environment in our hospitals which allows the patient, regardless of color, to receive the highest standard of care which can be provided, we must accept this information for what it is, the truth, even though it may be uncomfortable. Embracing that discomfort will allow providers to realize their own biases and not allow any perpetuation of this issue affecting millions.

On the intrapersonal level, physicians’ personal biases, whether conscious or not, affects treatment speed and efficiency of patients with different racial backgrounds. According to studies referenced in the article Can Health Care Be Cured of Racial Bias? by April Dembosky, African-Americans who present with the same symptoms and chief complaints as whites receive on average less prescription pain medication. Dembosky also states, “Black patients with chest pain are referred for advanced cardiac care less often than white patients with identical symptoms.” This chasm between whites and blacks receiving proper care adumbrates the prejudice and racism which exists in ambivalence, griping minorities with anxiety who seek treatment, while not affecting whites entirely, and completely results from health care providers acting upon their implicit biases.

Interpersonally, a lack of community understanding or acknowledgement of controversial fact perpetuates the inequality of health care outcomes. Studies, such as one published in the National Institute of Health’s National Library of Medicine stating that blacks were less likely than whites to receive opioid analgesics for the same health conditions, rarely make headlines. It is an unpopular topic of discussion to propose that those in charge of saving lives may also be treating patients differentially due to race and biases, a topic which is uncomfortable perhaps for the reason that it may install worry, and rightfully so, in such affected populations who will call upon these care providers for treatment in the future. Those who do find information on this subject may dismiss it because, similar to climate change, it is easier to dismiss an issue as being untrue than it is to try and generate a plausible solution. Whether it is due to ignorance of fact or blindness of truth, the lack of community involvement preserves the biases which leave some recipients of care behind. Were there more news coverage of such disparities, the public would pressure health institutions in which the gap is most extreme and catalyze positive change.

In the broader scope of public policy, there exists no legislation or regulation which standardizes the clinical pathways, the ideal sequence of treatment and timing of such care for a particular diagnosis, which must be followed for any patient, regardless of race. A mandatory level of standardization ensures equality for treatment of all groups, indifferent to the biases of any particular health care provider. Perhaps if such a standardization was incentivized, such as a penalty on insurance payments to the institution for differential health outcome due only to a difference in race without other complications, there could be a positive impact on reducing the difference in treatment of varying ethnicities with the same diagnosis.

According to the International Consortium for Health Outcomes Management, “We believe outcomes are the ultimate measure of success in health care.” If this is indeed the case, then our current health care system is blatantly failing the needs of underrepresented populations, and it is not only our responsibility, but our duty as the future of health care to establish an equity so desperately missing from our care of individuals, regardless of cultural background or ethnicity. To truly call oneself a health care provider, one must do so without difference of color or creed, for to do so is a disservice to not only the patient, but the entirety of the health care community.

What do you think is a good way to help break the cycle of prejudice and bias in our health care system? Is it feasible to dream of a health care system without prejudice?

Health Disparities and Diabetes

Health Disparities and Diabetes

As we learned in lecture, a health disparity is an inequality that occurs in healthcare and access to healthcare across different racial, ethnic, and socioeconomic groups. A prime example of a health disparity is diabetes, which African Americans, Latinos, and lower income earners are twice as likely to develop than white people and higher income earners are. They are also much more likely to suffer from complications due to their diabetes, such as leg amputations.

How does the Social- Ecological Model (SEM) help to explain this health disparity? On the societal level, Hispanics and Blacks make only a percentage of what white men make, even if they are doing the same job. With less money, these populations are unable to pay for the best health care. Also, statistically, lower income patients were far less likely to receive the yearly tests recommended by the American Diabetes Association. Hispanics and African Americans also have a much smaller chance of meeting the A1C goal than whites. Also, even though most clinicians know that diet and physical activity play a huge role in maintaining diabetes, fewer Hispanics, African Americans, low income earners, and people with less than a high school education were never given instructions for a changed diet or increased physical activity by their physicians. On the community level of the SEM, diabetes in poor areas is more prevalent, and many patients have worse outcomes than those in upper class neighborhoods. Why is that? Is it because they can not afford the healthier diet, or their health care providers are not as good as those in rich areas? On the individual level, if I barely have enough money to buy cheap food, how am I supposed to change my diet completely to healthier options? If I have to work my minimum wage job sixty hours a week, how am I going to exercise more? The other factors in my life, due to my socio-economic position, make it much harder for me to improve my condition.

One initiative that has been implemented to help inform more patients about their condition and how to improve it, is for doctors to learn medical Spanish. This is allowing more doctors to communicate more clearly with their Hispanic patients. On an individual level, this initiative will increase Hispanic patients’ knowledge about what they need to do to maintain their diabetes and keeping it from getting worse.

Socioeconomic Disparity in Healthy Eating

Socioeconomic Disparity in Healthy Eating

The organizational aspect of SEM plays a huge role in socioeconomic disparity in healthy eating.  Fast food and other unhealthy meals generally are very cheap.  In some cases, the $1 menu at McDonalds might be a person’s only option.  In comparison, someone of higher economic status might be more likely to not only eat well, but eat all organic or become a vegan or be gluten free by choice.  The prices of food largely limit the availability of healthy options because people simply cannot afford it.  Another aspect on the organizational level of SEM is food availability.  In college, students eat what the dining hall offers.  It doesn’t matter if it is healthy or not, people will eat it because that is their only option.  On the interpersonal level, people generally follow the same health patterns as their friends and families.  As children, we completely depend on our parents to decide what we will be eating each day.  Because of this, their healthy or unhealthy habits are generally passed down to their kids. Finally, on the intrapersonal level, each individual’s knowledge about food defines how healthy or unhealthy a person is. Someone of lower socioeconomic class might not have the same education and knowledge regarding diet and healthy eating as someone of higher status.  In addition, we are not all chefs, and do not all have the skills to create grand yet healthy meals.

 

A simple intervention on the interpersonal level is buying a cookbook.  Cookbooks can provide a variety of healthy meals.  They are usually easy to follow and allow others to teach us their cooking skills and ideas.  Regardless of socioeconomic class, anyone can follow a cookbook and make a good, healthy meal.  In doing so, we expand our cooking knowledge.

Health Disparities and Cancer

Health Disparities and Cancer

A current heath issue that affects many individuals is the plague of cancer. This awful disease takes loved ones from many families. Yet, minorities are affected by cancer more often than their white counter parts. It is estimated that the incidence rate of cancer is 10% higher in African Americans than it is for their white counterparts. Health disparities like this can be modeled along a framework called the Social Ecological Model (SEM). This framework helps to show how public policy, community, organizational, interpersonal, and intrapersonal reasons all relate in an aspect of health, whether that be a solution to a health issue or a health disparity. Using the health disparity of cancer within the African American community it can be seen that various aspects of the SEM that these factors can be used to perpetuate this disparity. On an intrapersonal level the lack of knowledge about cancer within the African American community than in the white community perpetuates this disparity. The lack of knowledge of this disease leads to less recognition of the early symptoms that could lead to effective treatment and less awareness to risk activities that could cause cancer. On an interpersonal level, African American families are less supportive during an illness than their white counterparts in order to breed the idea of making individuals tough. This inadequate support system will drive African Americans to not seek support for cancer and other cancer related high risk behaviors. Lastly, on an organizational level there is little support for individuals and little to no resources for individuals affected by cancer or high cancer risk behavior. These different ways that this awful health disparity are perpetuated exemplify areas that we as a society should strive to change and support.

These health disparities that affect minorities do not have to be a permeant. We as health care professionals can lead the charge in the elimination of health disparities. This could be done on many levels of the SEM. One way would be on the community level by giving cancer screenings through social organizations such as a church or a community organization. This intervention at the community level could increase awareness of this awful disease within the African American community and the cancer screenings could detect early signs of this disease allowing for early treatment and survival against cancer. The higher treatment and survival rate would be a good step in the right direction to improving this health disparity. As health professionals we all hope to do the best for our patients and their wellbeing; no matter their race, gender identity, sexuality, or any other factor.

Health Disparities & Obesity

Health Disparities & Obesity

As we learned in class, the Socio-Ecological Model shows how different levels of society are affected by a variety of health issues, with its main focus on the public policy aspect of it. There’s no doubt that many health disparities continue to exist in the world today with larger issues more known to us such as social injustice and health care coverage, yet sometimes we forget that other issues such as obesity or geographical location have a large impact on health disparities as well.

One example of a health care disparity that many continue to face today is the lack of healthy food options in our communities that ultimately lead us to make poor food choices on a daily basis. In relation to the Socio-Ecological model, an individual may choose to depend on fast-food chains due to limited income or easy accessibility to these places. In addition, having these fast food options is efficient for us to simply grab food to-go and continue on with our busy lives which is one of the reason why many people turn to this lifestyle. Following the personal level, it then spreads to the relationship/interpersonal level where the individual’s closest social circle, partners, and family members become influenced by their behavior and start to experience similar lifestyles. And as a result, these poor food choices can lead to obesity if proper exercise is not consistently maintained. Lastly, the public policy / societal aspect is looked at as we seek to identify the characteristics of these settings that are associated with poor health choices, and why many people so easily fall victim to this.

There are many smaller issues that can lead to health disparities and making poor food choices is just one of many. Although we might not consider it a big deal, these unhealthy lifestyles can lead to larger issues for many low-income individuals such as a high risk of obesity and/or the inability to receive adequate quality care, which in turn can lead to poorer health outcomes. These small issues may not seem significant compared to the social injustice of minority groups we hear about all over the news, yet it’d be foolish of us to ignore them until they become an even larger issue.

Some of the key initiatives that are helping to reduce health disparities are the 2011 Department of Health and Human Services (HHS) Disparities Action Plan, and the Affordable Care Act (ACA). According to the Kaiser Family Foundation, the Disparities Action Plan sets out a series of priorities, strategies, actions, and goals to achieve a vision of “a nation free of disparities in health and health care”. On the other hand, the ACA helps to increase coverage option for low-and moderate-income populations and includes other provisions to address disparities. One way we can personally address health disparities is by making smarter choices about our diet and thinking of the long-term effects caused by these. Healthy eating is not necessarily about strict dietary limitations, but also about depriving ourselves of the unnecessary, fattening foods we love. If we can educate our communities about the importance of eating healthier, obesity rates wouldn’t be as profound an issue and poor health outcomes wouldn’t be as prominent in the world.

Health Disparities & Unconscious Bias

Health Disparities & Unconscious Bias

The Institute of Medicine defines The Ecological Model as “a model of health that emphasizes the linkages and relationships among multiple factors (or determinants) affecting health.” Within this model, there are several different levels: social, community, institutional, interpersonal, and individual.

When looking deeper into the health care system, it is evident that health disparities exist. One example of a health care disparity is that low-income individuals receive poorer quality care and experience worse health outcomes. This fits into the Social Ecological Model because initially, an individual experiences poor care or even has an outcome as severe as death. After this happens, it spreads to the interpersonal level where the family of the individual is experiencing similar outcomes. It goes a step further when it is seen in the institutional level.

Sadly, this disparity exists against the socio-economically challenged because in our society those who have the most generally do not need the most. Furthermore, society may view those who are not very wealthy as less important and in result, the disparity is formed.

There are many interventions that can be/are done to help reduce the magnitude of health disparities against the socio-economically challenged. One is the Robert Wood Johnson Foundation (RWJF) which started an initiative called “Finding Answers: Disparities Research for Change to encourage, evaluate, and disseminate new interventions to reduce disparities” (www.solvingdisparities.org). RWJF acts on the community/social level of the SEM and it is now in its fourth year.

Health Disparities: Racism

Health Disparities: Racism

First off, what is the definition of a disparity? 

A disparity is a type of health difference that is closely linked with social, economic, and/or environment.

With that, it is good to be aware that disparities in the health care system very much still exists especially in social aspects. Mary Bassett explained it well in her TEDMED talk “Why your doctor should care about social justice.” It is because as much as we try to avoid talking about it because it is an uncomfortable topic to discuss, race is still an issue in this day and age.

Using the socioecological model, it starts with a patient or a friend, an individual, that you may know that is discriminated for his or her skin color, then it leads to a community of that same race being neglected by an institution to be given the care that they need; it becomes interpersonal, which leads to the healthcare systems having the problem they have now, which is social injustice in their system, leading to an organizational involvement.

It is because we are bias people. We are biased towards our own race or to the race that we as a society have deemed as “good.” Statistically, Basset brought up plenty of examples of racial injustice in the healthcare such as, premature mortality being 50% higher for black men than white men; black women facing death related to childbirth more than ten times related than white women; how black babies face three times the risk of early death in its first year of life than a white baby, and that more than one out of every six black men die earlier than white men with living only about 25 years of their lives. There is an ongoing discrimination, and it must be stopped especially in the healthcare. It should not matter what the color of the person’s skin is. If they are in need of medical care, help them.

Intervention actually happens often with just a person who is willing to speak up for the injustice witnessed.  However, it is a long process. It is a fight against you and many others until you have found people who are willing to be courageous enough to fight the same battle that you are fighting. It is the only way to stop the ongoing levels of health disparities in the socio-ecological life that we live by. You just have to “Sound the Alarm!”