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March 31, 2008
Health disparties in the California Medi-Cal program
From UCLA:
In the first external analysis of the California Department of Health Service's Medi-Cal Managed Care program, researchers from the UCLA Department of Family Medicine found widespread health care disparities based on ethnicity, race and language throughout the system.
And African Americans are bearing the brunt of it.
Specific findings included the following:
* 62 percent of African American children received all six recommended childhood vaccinations, compared with 67 percent of non-Hispanic whites, 78 percent of Hispanics and 82 percent of Asians/Pacific Islanders.
* 43 percent of African American women received breast cancer screenings, compared with 49 percent of non-Hispanic whites, 55 percent of Hispanics and 56 percent of Asians/Pacific Islanders.
* At 66 percent, African Americans with diabetes have the lowest rate of hemoglobin AIc testing, compared with 71 percent for non-Hispanic whites, 75 percent for Hispanics and 76 percent for Asians/Pacific Islanders.
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Posted by: David Porter on March 31, 2008
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Category: Health Disparities
March 28, 2008
Notes from Unnatural Causes - Program 1
Below are some notes I made during the first episode of the PBS program Unnatural Causes.
The U.S. has the highest GNP in the world. It spends 2 trillion dollars on health care - around 50% of what all the world spends.
The U.S. ranks 30th in life expectancy. More babies die in the 1st year in the U.S. than Cyprus.
47 million have no health coverage.
Why are we sicker? Individual diet? Individual behaviors?
Social determinants of health.
Twins who live together until 18 - if they diverge later in life they end up of with different health status.
In the UK - death rates and illness correlate with status even after controlling for health behaviors.
In the US - social gradients exist similar to those in the UK. Over 70% of affluent report very good to excellent health. Good health decreases with income.
College graduates live 2.5 years longer than high school graduates.
In Louisville, KY - life expectancy can vary greatly between districts. Up to 9 years difference between some districts.
Can social policies drive health? What constitutes 'social class?'
Does living in a higher social class give more control over one's life? Does more control lead to better health?
Lack of control leads to stress. Stress raises blood pressure and increases glucose. Stress helps motivates and aids in 'fight or flight' situations. However, if stress is constant too much cortisol is produced leading to lower immune strength.
Chronic stress may affect those more that have less control (subordinates.) Chronic stress from lack of control may lead to atherosclerosis.
Chronic stress (as measured by cortisol) may lead an increases chance of catching the common cold. This may indicate a diminished immune system.
Note - people with more bosses may have more chronic stress leading to compromised immune systems. High demand - low control.
Most of the poor in America are white.
The more years parents own a home the less likely their children are to catch a cold when exposed (lab environment.)
Health outcomes for African-Americans are worse than whites across the social gradients.
83,000 'excess death' each year for African-Americans.
In the early 1900s gov't programs helped many whites to live longer.
Often times non-medical interventions affect health the most. Housing programs and universal education for example.
Economic policy is health policy.
Since the 1980s - gov't slashed programs - reduced taxes for the wealthy - and inequality increased.
The U.S. is the most unequal of the world's democracies.
Countries that have a more equitable distribution of wealth are healthier.
The current generation of young adults may be the first to live shorter lives than their parents.
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Posted by: David Porter on March 28, 2008
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Category: Health Disparities; Unnatural Causes
March 27, 2008
More work to do
This week's issue of JAMA has Rebecca Voelker writing about the progress of reducing health disparities after decades of work.
The early weeks of 2008 brought discouraging news for advocates working to narrow health care disparities among racial and ethnic groups. In rapid succession, several studies published in January in peer-reviewed journals showed that despite decades of efforts to raise awareness about disparities and to reduce them, the gaps in some key treatment areas have not budged.
The latest findings build on years of research that has established the extent of inequalities in treatment for cancer, heart disease, diabetes, and many other conditions.
The article provides several possible explanations for the disconnect. For example, when quality of care improves both the majority and minority populations see improved outcomes. If the rate of improvement is the same for both groups any disparity remains unchanged.
The article also states that interventions tend to target one aspect of health care delivery. In a complex system that may not be enough.
Finally, it may be time to move past identifying health disparities and focus efforts on reducing disparity.
BONUS - Tonight at 10pm begins the PBS series Unnatural Causes: Is Inequality Making Us Sick.
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Posted by: David Porter on March 27, 2008
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Category: Health Disparities
March 26, 2008
The weaker sex - updated
In an earlier post we noted that some health conditions affect males more than females. For example, males are more likely to have developmental disorders such as autism and dyslexia.
A new study reports that although boys continue to have a higher infant mortality rate than girls the gap is shrinking.
30 years ago boys had a 30% higher risk of dying by age 1 than girls. Today it is about 20%.
In the past three decades, the gap has closed a bit, with boys this decade having roughly a 20 percent higher chance of death by age 1 than girls, according to Eileen Crimmins of the University of Southern California, one of the researchers.
The article continues by saying that while while adult males engage in more risk taking behaviors the causes of infant mortality rates are mostly biological.
Boys are 60 percent more likely than girls to be born prematurely and to have conditions tied to pre-term birth such as neonatal respiratory distress syndrome, a condition that makes it difficult for a baby to breathe, the researchers said. This syndrome can occur in infants whose lungs have not yet fully developed.
Infant boys also face a higher risk of birth injury and mortality due to their larger body and head size, they said.
The complete study can be found at the Proceedings of the National Academy of Sciences.
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Posted by: David Porter on March 26, 2008
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Category: Health Disparities
March 24, 2008
Disparities in life expectancy
From NYTimes.com:
New government research has found “large and growing” disparities in life expectancy for richer and poorer Americans, paralleling the growth of income inequality in the last two decades.
Life expectancy for the nation as a whole has increased, the researchers said, but affluent people have experienced greater gains, and this, in turn, has caused a widening gap.
One of the researchers, Gopal K. Singh, a demographer at the Department of Health and Human Services, said “the growing inequalities in life expectancy” mirrored trends in infant mortality and in death from heart disease and certain cancers.
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Posted by: David Porter on March 24, 2008
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Category: Health Disparities
March 20, 2008
Access to health care and sexual orientation in Canada
From Canada.com:
"The theory is that disenfranchised groups might access (the health-care system) differently, might have difficulty accessing it, so we wanted to look at whether this is also the case for sexual orientation," said the study's author Michael Tjepkema.
"It is true that gays, lesbians, bisexual men and women do access different types of the health-care system differently from heterosexual Canadians," he said of his findings.
"The striking example for me would be looking at lesbians and Pap smear testing," said Tjepkema.
Less than two-thirds of lesbians reported having a Pap test within three years of the survey, well below the more than three-quarters of heterosexual and bisexual women who had the screening test.
"The lower screening rate among lesbians could be in response to past negative experiences with health-care providers, the belief that the test is not necessary, or not usually taking birth control pills, renewal of prescriptions for which can be an opportunity for doctors to discuss and administer the Pap test," the study said.
Lesbians and bisexual women were also less likely to report having a regular family doctor than heterosexual women, the study found.
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Posted by: David Porter on March 20, 2008
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Category: Health Disparities
March 19, 2008
Unregulated Health Care?
Connecticut officials say the health clinics that are showing up in Wal-Mart and CVS stores may need to be regulated.
From Hartford Business:
Minnesota-based MinuteClinic, which was acquired by CVS in 2006, now operates in 16 CVS stores in the state. The clinics tend to charge between $50 and $80 per visit, making them highly attractive to uninsured patients who can’t afford more expensive trips to physicians.
“They are starting to pop up all over Connecticut and, as we see it, there’s no real oversight,” said Ken Ferrucci, director of government relations for the Connecticut State Medical Society. “We want to see how they’re going to fit in the public health discussion because right now we don’t like it that they are part of the system.”
Edited 3/31/08 - CVS has several MinuteClinics in the in the Cleveland area. A websearch found no WalMart clinics in the Cleveland area. However, Walgreens has several Take Care Health Centers in Northeast Ohio.
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Posted by: David Porter on March 19, 2008
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Category: Healthcare
March 18, 2008
Your vitals: blood pressure, pulse, credit score
The Health Blog has a post about how credit scores are becoming the new vital sign in health care:
To figure out which patients are likely to pay their bills and which ones are best written off as charity cases, hospitals are peering into patients’ financial records.
Some are using traditional credit scores that are used for things like car loans and mortgages. Others are buying reports specially tailored to predict the likelihood that a patient will pay a big medical bill....
The Wall Street Journal has the original story.
The Journal also says that some hospitals are checking credit at the door while others wait for the final bill to be tallied. Also, a new 'health care credit score' is being developed so hospitals can better target collection efforts. From the Journal:
[Orlando Regional Healthcare] figures there's little to be gained from applying more pressure to either low- or high-risk patients. But "we're trying to work with that [medium-risk] population more to try to find some method of payment," says Keith Eggert, Orlando Regional's vice president of revenue management.
How long before non-emergency treatment is denied because of a low 'health care credit score?'
White Coat Rants has a good summary of the issue.
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Posted by: David Porter on March 18, 2008
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Category: Health Care
San Francisco restaurants adding 'tax' to bill to pay for universal healthcare
San Francisco eateries have started adding a surcharge to restaurant meals to help pay for the city's new insurance program:
From latimes.com:
In the hip South of Market neighborhood, the menu at Tres Agaves, a popular Mexican restaurant and tequila bar, has a small message at the bottom of the first page that says, "3.5% service charge will be added to all checks for the San Francisco affordable healthcare legislation."
At issue is the city's new effort, kicked off Jan. 9, to provide healthcare for all residents. Since then, employers with more than 20 workers are required to spend a minimum amount on health insurance, set aside money in health reimbursement accounts or pay a fee to the city's Healthy San Francisco program.
The restaurant surcharges are spreading. Market Street favorite Zuni Cafe charges 4% of the total bill. Others, including Delfina, a trendy Mission District trattoria, collect a flat fee of $1 to $2 per person.
Other restaurants hide the 'fee' in their food costs to not alert patrons to the charge.
A trade association has filed suit in hopes of stopping the mandated tax. Oral arguments will be heard in April.
NPR has an audio report of the San Francisco universal health care plan.
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Posted by: David Porter on March 18, 2008
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Category: Health Care
March 17, 2008
Ohio television station tests the health care system
A Cincinnati television station decided to test the health care system after getting numerous complaints about Anthem Insurance company. Many of the complaints were about mental health care and how Anthem responded to their claims.
That’s when we [WCPO] first told you that the governor of Ohio was asking for an investigation after we made him aware of complaints about Anthem Insurance company.
Since then, the I-Team’s continued to get complaints that the situation is getting worse. So we decided to test the system ourselves, and to find out what happened to that state investigation the Governor promised.
One person named Kate called over 50 providers that were listed as 'in-network.' Out of those 50 - only 8 still accepted Anthem patients and 5 refused to give her an appointment.
"It does not pay for us to take Anthem. It does not cover our overhead," said an office manager for a local psychiatrist's office who asked us to hide her identity because she fears retaliation from Anthem. She says she hears from patients like Kate every day.
Then WCPO's I-Team called 17 mental health providers at Cincinnati's Children's Hospital. They found only 5 providers willing to see new patients.
The state's Department of Insurance looked into the matter and found no violations of existing Ohio law. However, further investigation by the I-Team discovered that the review by the Department of Insurance was based on information provided from Anthem.
Hamilton County eventually dropped Anthem as an insurer.
The full story at WCPO.com.
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Posted by: David Porter on March 17, 2008
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Category: Health Care
March 13, 2008
Diabetes mortality rates in youths
From JAMA:
To assess racial disparities in diabetes mortality among youths, CDC analyzed data on deaths with an underlying cause of diabetes among persons aged 1-19 years for the period 1979-2004. This report summarizes the results of that analysis, which determined that, during 1979-2004, diabetes death rates for black youths were approximately twice those for white youths. During 2003-2004, the annual average diabetes death rate per 1 million youths was 2.46 for black youths and 0.91 for white youths.
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Posted by: David Porter on March 13, 2008
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Category: Health Disparities
March 12, 2008
Disparities in teen sex-related diseases
From Reuters:
An estimated 3.2 million U.S. girls ages 14 and 19 -- about 26 percent of that age group -- have a sexually transmitted infection such as the human papillomavirus or HPV, chlamydia, genital herpes or trichomoniasis, the CDC said.
Forty-eight percent of black teen-age girls were infected, compared to 20 percent of whites and 20 percent of Mexican American girls. The report did not give data on the broader U.S. Hispanic population.
From USNews:
Race itself is not a risk factor for STDs, [Dr. Sara Forhan] said. However, factors such as limited access to health care, poverty, community prevalence of STDs, and misperceptions about individual risk are some of the reasons that STD rates are particularly high among African-Americans, she said.
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Posted by: David Porter on March 12, 2008
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Category: Health Disparities
Health, income, and Native Americans
From SeattlePI:
Urban American Indians face a health problem unseen by other races, researchers say: As they become wealthier, their rates of binge drinking and tobacco use stay the same or rise.
The nonprofit Urban Indian Health Institute also said diabetes and obesity rates were about the same for urban Indians, whether they were rich or poor. Among other races, people with higher incomes tend to have fewer of those health problems than poorer people.
"When Indian folks drink, it appears to have nothing to do with how much money they have, and that's not true for any other racial group," said Maile Taualii, the institute's scientific director.
The Urban Indian Health Institute can be found on the web at uihi.org.
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Posted by: David Porter on March 12, 2008
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Category: Health Disparities
March 11, 2008
Health Affairs - Health Disparities Edition
The March/April 2008 edition of Health Affairs is focused on the topic of health disparities.
Browsing the table of contents we see such topics as: social determinates of health, racial and ethnic disparties in mental health, quality of care in minority populations, and trends in the cost of care and the uninsured.
We will try to highlight some of these articles over the next few weeks.
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Posted by: David Porter on March 11, 2008
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Category: Health Disparities
Racial disparities in hospital death rates
From the Star Bulletin:
Asian, Pacific Island and African-American patients have a higher risk than Caucasians of dying in hospitals after suffering injuries, according to a study co-authored by the new dean of the John A. Burns School of Medicine.
The full study can be found in the journal Medical Care.
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Posted by: David Porter on March 11, 2008
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Category: Health Disparities
March 10, 2008
Medical Apartheid
Democracy Now's Amy Goodman and Juan Gonzalez interviewed Harriet Washington about her new book, “Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present.”
Ms. Washington shared this story from her past:
Well, I came across some old case files in a forgotten file folder, and one was of a black gentleman, one was of a white gentleman.
The white gentleman’s file was thick and full of testaments to his loving family, his insurance support, his determination to live and detailed really Herculean attempt on the part of medical personnel to procure a kidney for him, kidney transportation still being relatively new then.
The file of the black gentleman was very thin. The word “Negro” appeared on every page of it, and somebody had underlined it on a social profile, right above the single line that indicated that the medical staff’s plans for him were to help him to prepare for his imminent demise.
The white gentleman and the black gentleman were very similar in their profiles, but they were treated differently, and I wanted to know whether this was a consistent feature of medical care or just an anomaly. And as I began looking into it, I just became intrigued in the vast differences in the way African Americans were used in research.
You can read the full transcript, watch, and listen to the interview at Democracy Now.
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Posted by: David Porter on March 10, 2008
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Category: Health Disparities
March 06, 2008
Addressing the Mental Health Disparities Evident in the African American and Latino Communities - A Grassroots Approach
The Case Center for Reducing Health Disparities and Cleveland State University's Center for Health Equity are co-sponsoring the next lecture in our Works in Progress series.
"Addressing the Mental Health Disparities Evident in the African American and Latino Communities - A Grassroots Approach" will be presented by:
Marsha Mitchell Blanks, M.S.W., L.S.W.
Evelyn Rivera-Mosquera, Ph.D., M.P.H., M.A.
Date: Friday, March 14, 2008
Time: 3-4 pm
Location:
LOCATION:
Case Western Reserve University- Medical School- T503
2109 Adelbert Avenue, Cleveland, Ohio
Please RSVP your attendance to Catherine Oakar at cro5@case.edu or by phone at (216) 778-1357.
We look forward to seeing you there!
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Posted by: David Porter on March 06, 2008
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Category: Works in Progress
Elder Abuse: Framing the Issue
"Elder Abuse: Framing the Issue"
Presented by Georgia Anetzberger, PhD, ACSW, LISW on February 8, 2008 as part of our Works in Progress series.
Cleveland State's Center for Health Equity was the host of this lecture.
See this page for information on downloading and subscribing to our podcast.
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Posted by: David Porter on March 06, 2008
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Category: Audio / Video
March 05, 2008
Win the lottery and get insurance
Oregon is conducting a one-of-a-kind lottery, and the prize is health insurance.
Those selected in the lottery will be eligible for a standard benefit program, which was once a heralded highlight of the Oregon Health Plan.
At its peak in 1995, the program covered 132,000 Oregonians. State budget cuts forced the program to close to newcomers by 2004, but it now has several thousand openings.
The program covers their most basic health services, medications and limited dental, hospital and vision services at little or no cost.
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Posted by: David Porter on March 05, 2008
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Category: Health Care
March 04, 2008
Disparities in mortality rates in low birth weight babies
From CommonweathFund.org:
Black babies with very low birth weights are nearly twice as likely as their white counterparts to be born at New York City hospitals with high risk-adjusted neonatal death rates, according to a study published in Pediatrics and conducted with support from The Commonwealth Fund, the Agency for Healthcare Research and Quality, and the National Center for Minority Health and Health Disparities.
Only 11 percent of white babies with very low birth weights—weighing less than 3 pounds, 5 ounces (1,500 grams)—were born at New York City hospitals with high risk-adjusted death rates, versus 21 percent of black very-low-birth-weight (VLBW) infants.
The full study can be found in Pediatrics.
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Posted by: David Porter on March 04, 2008
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Category: Health Disparities
March 03, 2008
Sidney M. Wolfe, M.D.
Sidney M. Wolfe, M.D. will be visiting the Center for Reducing Health Diparities tomorrow.
Dr. Wolfe is the founder and director of the Health Research Group at Public Citizen.
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Posted by: David Porter on March 03, 2008
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Category: About Us