Health Care Disparities

Health Care Disparities

Goal:

  • To assess a clinical issue that is the focus of the Quality Improvement Project.
  • Create a SWOT (strengths, weaknesses, opportunities, threats) analysis for the project. Faculty approval required to proceed.

Content Requirements:

  1. Identify strengths, weakness, opportunities, and threats for improvement related to the clinical issue identified.
  2. Analyze the SWOT data to provide the foundation for an action plan for quality improvement. Health Care Disparities

Submission Instructions: 

  • The paper is to be clear and concise, and students will lose points for improper grammar, punctuation and misspelling.
  • The paper is to be 2 – 3 pages in length, excluding the title, abstract and references page.
  • Incorporate a minimum of 3 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.
  • Journal articles and books should be referenced according to current APA style (the library has a copy of the APA Manual).

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As part of its statement of task, the committee was asked to review the state of health disparities in the United States and to explore the underlying conditions and root causes contributing to health inequities and the interdependent nature of the factors that create them (drawing from existing literature and syntheses on health disparities and health inequities). In this chapter the committee reviews the state of health disparities in the United States by race and ethnicity, gender, sexual orientation and gender identity, and disability status, highlighting populations that are disproportionately impacted by inequity. In addition, this chapter summarizes data related to military veterans as well as rural versus urban-area differences. The committee drew on existing literature, comprehensive reviews (AHRQ, 2016; NCHS, 2016), and recent studies. In Chapters 2 and 3, the report features examples of communities that are taking action to address the root causes of health inequity. These brief examples are meant to be illustrative of the work being undertaken by communities throughout the country. In Chapter 5 the report takes a more in-depth look into nine examples of community-driven solutions to promote health equity Health Care Disparities.

HEALTH DISPARITIES

For the purposes of this report, health disparities are differences that exist among specific population groups in the United States in the attainment of full health potential that can be measured by differences in incidence, prevalence, mortality, burden of disease, and other adverse health conditions (NIH, 2014). While the term disparities is often used or interpreted to reflect differences between racial or ethnic groups, disparities can exist across many other dimensions as well, such as gender, sexual orientation, age, disability status, socioeconomic status, and geographic location. According to Healthy People 2020, all of these factors, in addition to race and ethnicity, shape an individual’s ability to achieve optimal health (Healthy People 2020, 2016). Indeed, the existing evidence on health disparities does reveal differential health outcomes across and within all of the aforementioned identity groups. Health disparities can stem from health inequities—systematic differences in the health of groups and communities occupying unequal positions in society that are avoidable and unjust (Graham, 2004). These are the type of disparities that are reflected in the committee’s charge and that will be addressed for the remainder of this report. In this section, we describe health disparities affecting populations across multiple dimensions Health Care Disparities.

Racial and Ethnic Disparities

Race and ethnicity are socially constructed categories that have tangible effects on the lives of individuals who are defined by how one perceives one’s self and how one is perceived by others. It is important to acknowledge the social construction (i.e., created from prevailing social perceptions, historical policies, and practices) of the concepts of race and ethnicity because it has implications for how measures of race have been used and changed over time. Furthermore, the concept of race is complex, with a rich history of scientific and philosophical debate as to the nature of race (James, 2016). Racial and ethnic disparities are arguably the most obstinate inequities in health over time, despite the many strides that have been made to improve health in the United States. Moreover, race and ethnicity are extremely salient factors when examining health inequity (Bell and Lee, 2011; Smedley et al., 2008; Williams et al., 2010). Therefore, solutions for health equity need to take into account the social, political, and historical context of race and ethnicity in this country.

The criteria people use to classify themselves and others racially and ethnically and the attitudes that people hold about race and ethnicity have been changing significantly in the early 21st century. According to the U.S. Census Bureau, 37.9 percent of the population was identified to be racial or ethnic minorities in 2014 (NCHS, 2016). “Minority” populations, which already constitute majorities in some cities and states (e.g., California), will become the majority nationwide within 30 years. By the year 2044, they will account for more than half of the total U.S. population, and by 2060, nearly one in five of the nation’s total population will be foreign born (Colby and Ortman, 2014).

For racial and ethnic minorities in the United States, health disparities take on many forms, including higher rates of chronic disease and premature death compared to the rates among whites. It is important to note that this pattern is not universal. Some minority groups—most notably, Hispanic immigrants—have better health outcomes than whites (Lara et al., 2005). This “immigrant paradox” appears to diminish with time spent in the United States, however (Lara et al., 2005). For other indicators, disparities have shrunk, not because of improvements among minorities but because of declines in the health of majority groups. For example, white females have experienced increased death rates due to suicide and alcohol-related diseases. Research suggests that the recent drug overdose epidemic, along with the rise of suicide and alcohol-related diseases, has contributed to the first increase in the national death rate in decades and to the unusual recent decline in life expectancy for white females (Arias, 2016; Case and Deaton, 2015; NCHS, 2016)Health Care Disparities.

Although significant progress has been made in narrowing the gap in health outcomes (NCHS, 2016), the elimination of disparities in health has yet to be achieved. Furthermore, this narrowing of health gaps does not hold true for a number of outcomes. Rather, despite overall improvements in health over time, some health disparities persist. This is true with many human immunodeficiency virus (HIV)-related outcomes. For instance, the magnitude of the African American–white disparity in acquired immunodeficiency syndrome (AIDS) diagnoses and mortality has actually grown substantially over time (Levine et al., 2001, 2007).

Infant gestational age, which is an important predictor of morbidity and infant mortality, differs among racial and ethnic groups. The National Center for Health Statistics (NCHS) reports that among the five racial and ethnic groups measured in the National Vital Statistics Survey (NVSS) in 2014, African American women had the highest percentage of preterm singleton births at 11.1 percent, while Asian or Pacific Islander women had the lowest at 6.8 percent (NCHS, 2016). Within the Hispanic ethnic group, there is considerable variation in health outcomes based on country of origin. For example, the 2014 NVSS findings revealed that Puerto Rican mothers had the highest percentage of preterm singleton births at 9.1 percent, and Cuban mothers the lowest at 7.2 percent (NCHS, 2016).

While national infant mortality rates decreased overall by 14 percent from 2004 to 2014, disparities among racial and ethnic groups persisted (NCHS, 2016). For indigenous populations, infant mortality rates are staggering. Native Americans and Alaska Natives have an infant mortality rate that is 60 percent higher than the rate for their white counterparts (HHS, 2014). In 2013, infants born to African American mothers experienced the highest rates of infant mortality (11.11 infant deaths per 1,000 births), and infants born to Asian or Pacific Islander mothers experienced the lowest rates (3.90 infant deaths per 1,000 births) (NCHS, 2016). In 2015 the percentage of low-birthweight infants rose for the first time in 7 years. For white infants, the rate of low-birthweight infants was essentially unchanged, but for African American and Hispanic infants, the rate increased (Hamilton et al., 2016).

Obesity, a condition which has many associated chronic diseases and debilitating conditions, affects racial and ethnic minorities disproportionately as well. This has major implications for the quality of life and wellbeing for these population groups and their families. From 2011 to 2014, Hispanic children and adolescents ages 2 to 19 had the highest prevalence of obesity in the United States (21.9 percent), and Asians had the lowest (8.6 percent) (NCHS, 2016). Again, there is variation among Hispanics; Mexican Americans suffer disproportionately from diabetes (HHS, 2015)Health Care Disparities.

Heart disease and cancer are the leading causes of death across race, ethnicity, and gender (see Table 2-1). African Americans were 30 percent more likely than whites to die prematurely from heart disease in 2010, and African American men are twice as likely as whites to die prematurely from stroke (HHS, 2016b,d). The U.S. Centers for Disease Control and Prevention (CDC) reports that nearly 44 percent of African American men and 48 percent of African American women have some form of cardiovascular disease (CDC, 2014a). Moreover, African American and American Indian/Alaska Native females have higher rates of stroke-related death than Hispanic and white women (Blackwell et al., 2014).

Leading Causes of Death by Race, Ethnicity, and Gender, 2013.

Homicide-related deaths, another instance of health disparities, are highest for African American men (4.5 percent) and are at least 2 percent for American Indian/Alaska Native and Hispanic men. The rate of suicide is highest for male American Indians/Alaska Natives, who are also more likely than other racial and ethnic groups to die by unintentional injury (12.6 percent of all deaths) (CDC, 2013d).

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It is important to be cautious with data on disparities in poverty, obesity, and diabetes for several reasons. First, surveillance and other data are adequate at capturing black–white disparities in part because of their large sample sizes. Other groups, however, are not studied in as much detail because their sample sizes can be small. Moreover, heterogeneous groups may be folded together—for example, Native Americans across tribes, rural and urban areas, or Pacific Islanders and Asians as one group—which may mask differences in poverty, obesity, and diabetes (Bauer and Plescia, 2014; Holland and Palaniappan, 2012). For Hispanics, an ethnic group among which there is substantial heterogeneity by country of origin, many data sources report health outcomes for the entire population, despite evidence for within-group variation on important outcomes such as HIV (Garcia et al., 2015). Relative to black–white disparities, the literature examining disparities across other racial and ethnic populations is extremely limited. Considering the significant growth of minority populations in the United States, the insufficient knowledge base to date about the health conditions of a number of these groups presents a serious challenge to understanding and addressing health disparities among specific populations Health Care Disparities.