April 30, 2008
Blogging Against Disablism Day
On May 1st the Health Disparities Blog will join a host of other medical bloggers with an entry focused on the topic of health disparities and disabilities.
More information can be found here.
Make sure you check back tomorrow.
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Posted by: David Porter on April 30, 2008
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Category: About Us
Cancer, stroke, and health disparities in China
China Daily is reporting on a new study by the Chinese Ministry of Health.
The study looked at the health of about 210 million Chinese across the nation. The primary finding was that cancer and stroke are the countries top killers.
In addition, the report found increasing disparities between the rural and urban areas of China.
The differences were reflective of the yawning gap between the country's rural and urban areas in terms of health awareness and living standards, [MOH spokesman Deng Haihua] said.
Disparities in economic development between rural and urban regions, which lead to an imbalance in medical care and health awareness, can influence the death rate in different areas, he said.
The number of deaths in the countryside was 19 percent higher than in urban areas. Within urban areas, the death rate in less developed western cities was 25 percent higher than in the more developed east.
Part of the problem is China's tremendous cigarette consumption. MSN reported that China consumes 2.3 trillion (2,300,000,000,000) cigarettes or two-fifths the world's total.
The China Daily article also mentions the infamous cucumber, "people in the rural regions of Hebei province like to eat homemade pickles that have high nitrite content, which can lead to cancer...."
You can read our other entries related to China at this link.
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Posted by: David Porter on April 30, 2008
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Category: Cancer; China; stroke
April 29, 2008
Hospital says payment before treatment
From the Health Blog at WSJ.com:
As a front-page article in today’s WSJ reports, hospitals are seeking cash upfront to reduce bad debt they’re experiencing amid a surge in patients who don’t pay their bills. Some are uninsured and other carry coverage that requires high co-payments.
Let us not forget a topic we blogged about earlier - medical credit scores and how they might influence treatment.
BONUS: A new study out reports that blacks have a 5x higher rate of amputations in the Chicago area.
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Posted by: David Porter on April 29, 2008
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Category: Access to Health Care; Health Care
April 27, 2008
Low Medicaid reimbursement may lead to disparities
From Health Affairs:
PCPs in high-minority practices rely more heavily on lower-paying Medicaid reimbursements, devote more time to uncompensated charity care, and earn lower incomes. Magnifying these resource disparities, geographic areas with more high-minority practices tend to have lower Medicaid and private insurance reimbursements than those with fewer high-minority practices.
Our results indicate that the minority makeup of physicians' patient panels is associated with greater reports from physicians of difficulties providing high-quality care. At least some of this relationship appears to be explained by the lower resources flowing to high-minority practices. Two of the quality indicators most affected by Medicaid payment levels in our simulations, time spent per patient seen and difficulties getting timely reports from other providers, suggest the possibility that physicians may compensate for the lower revenue flows by increasing the volume of patients they see, reducing the time spent per patient seen, and perhaps devoting less time to coordinating and documenting care. This is despite the more complex psychosocial contexts and the language and cultural barriers that often complicate the treatment of lower-income and minority patients.
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Posted by: David Porter on April 27, 2008
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Category: Health Care; Health Disparities; Medicaid Reimbursement
April 25, 2008
Sold her house to open a clinic
CNN.com has a story posted about a doctor who left private practice, sold her house, and opened a clinic focused on providing health care for the poor.
In 2002, these efforts resulted in "The Clinic: Medical Center for the Uninsured," a charitable, sun-filled clinic that has since received more than 40,000 patient visits.
Individuals receive free or low-cost primary medical care across eight specialties, regardless of income or locality.
"Since there's no need to spend a lot of time doing paperwork, we have time to talk to the patient and really hear what they're saying," says Stuart. "So the patients go away feeling they've been heard, that they've been helped."
An arsenal of more than 100 local volunteers, including 20 retired and practicing physicians, assist Stuart in providing expert medical services to more than 800 patients per month from across the southeastern Pennsylvania, New Jersey and Delaware area.
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Posted by: David Porter on April 25, 2008
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Category: Health Care
April 24, 2008
Health care around the world
Healthcare-Economist.com has been reviewing many of the national health care systems around the world.
The reviews are based on an article by Michael Tanner that appeared at Cato.org.
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Posted by: David Porter on April 24, 2008
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Category: Health Care
April 23, 2008
Racist Doctors?
Rahul K. Parikh, M.D. writing at Salon.com:
In 2002, the Institute of Medicine issued a sobering report about health disparities in America. In that report, the IOM challenged assumptions by asking one very hard question: Do doctors treat minority patients differently? Its answer, after reviewing more than 100 studies, was yes, "evidence suggests that bias, prejudice and stereotyping on the part of health care providers may contribute to differences in care."
Dr. Parikh furthers the discussion with a Harvard Medical School study that used computer images to test for implicit racial biases.
In that study researchers recruited internal medicine and emergency medicine residents in the Boston and Atlanta areas. Participants logged into a website and read a clinical vignette while viewing a picture of a black or white person.
The participants were then asked a series of questions regarding the source and treatment of the problem.
In their analysis the Harvard researchers reported no explicit biases by the participants with regards to black and white Americans. However, with regards to implicit biases negative attributes were assigned to blacks more often than whites.
From the Harvard study:
Not surprisingly, most physicians did not admit to any racial biases explicitly. However, on the implicit measures of bias (IATs), most nonblack physicians demonstrated some degree of bias favoring whites over blacks. Participants’ scores on the race preference IAT showed a range of implicit race bias similar to previous experiments on nonphysicians.
Back to Dr. Parikh.
Does this mean that doctors are racist? No. In fact, the discrepancy between explicit and implicit biases in the Harvard study suggests the opposite. But it's clear deeper biases exist, and for several reasons.
First, and most important, doctors are people. There's plenty of evidence that well-intentioned people, whatever their background, possess and demonstrate unconscious negative racial attitudes and stereotypes. Doctors are no different. We share many common conceptions about race in America. We bring those influences, right or wrong, with us to the office.
Dr. Parikh adds that the medical decision making process is often complex and the pressure of time forces the doctor to use shortcuts to arrive at a diagnosis. Stereotypes are just one of those shortcuts.
BONUS: If you are curious about implicit biases there is an online test by the University of Chicago. It looks at your response time in dealing with black and white males with and without a gun. Nicholas Kristof reports his results in this NYTimes.com article.
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Posted by: David Porter on April 23, 2008
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Category: Health Disparities
April 22, 2008
Disparities in the Organ Allocation System
"Disparities in Perceptions of the Organ Allocation System and Willingness to Donate Organs."
Presented by L. Ebony Boulware, MD, MPH, FACP
Date: Friday, April 25th from 9:00-10:30 a.m.
Location: MetroHealth Medical Center. 2500 MetroHealth Ave. Rammelkamp R219.
All are welcome to attend.
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Posted by: David Porter on April 22, 2008
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Category: Health Services Research Seminar
Life expectancy - It goes beyond race
From Reuters:
Smoking, obesity and high blood pressure are taking the lives of women in Appalachia, Mississippi River states and parts of Texas, a team at Harvard School of Public Health reported.
"There has been increasing disparity in health in the U.S. population for two decades," said Majid Ezzati of the school's department of population and international health, who led the study.
Overall U.S. life expectancy increased mostly because of fewer deaths from heart disease, the No. 1 cause of death, and stroke. But by the 1980s, death rates started to head back up in many counties.
"The majority of these counties were in the Deep South, along the Mississippi River, and in Appalachia, extending into the southern portion of the Midwest and into Texas," Ezzati's team wrote.
While many of the worst-affected counties had a high black population, Ezzati found that white populations in poorer counties fared worse that whites elsewhere, too.
"It exists above and beyond race," he said.
The study can be found free and online at PLoS Medicine.
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Posted by: David Porter on April 22, 2008
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Category: Health; Health Disparities; Longevity; racial differences
April 21, 2008
The bleak effects of poverty
From SFGate.com:
Illustrating the profound societal impact of chronic poverty, a new report released Thursday by the Alameda County Public Health Department documents health disparities by neighborhood, income and race. It highlights a widening social, economic and health gap in the county - as poverty goes up, life expectancy goes down.
"The data are overwhelming," said Dr. Tony Iton, the county's public health director. "It is shocking. It is not unique to West Oakland. You see it in Bayview-Hunters Point, in Richmond, in Cleveland and Detroit."
You can read the executive summary of the report at acphd.org.
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Posted by: David Porter on April 21, 2008
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Category: Health; Health Disparities; poverty
April 18, 2008
Health care and the youth in Australia
Australia's Medicare system provides free or low-cost universal care to all individuals.
Australians under the age of 15 can obtain their own Medicare card linked to their parent's account. Because the accounts are linked parents have access to all of their child's medical information.
The Australian newspaper The Age has an article discussing a new proposal that will help young Australians keep their medical details private.
From The Age:
[I]magine for a moment that you are a 14-year-old confused about your sexuality. You're too embarrassed to discuss this with your parents, or perhaps you have unsympathetic parents or come from a dysfunctional family. Wouldn't it be in everyone's best interests if you could talk in confidence to a trusted GP about this?
The proposed solution is the automatic distribution of Medicare cards to all Australian youths when they reach age 13.
This change to the Australian system has two components. First, Medicare cards will be distributed automatically. No longer will teenagers need to enroll in the system. Second, the age for an individual (not linked) Medicare account is lowered from 15 to 13.
Here in the U.S. the debate is focused on whether or not universal health care should exist. In Australia the issue is how young a person should be when they get their own private universal health care account.
For more information on the Australian Medicare system you can visit these links:
Medicare Australia at Wikipedia
Medicare system blamed for GP wage disparity
The Health Care system in Australia
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Posted by: David Porter on April 18, 2008
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Category: Health Care; Universal Health Care
April 16, 2008
What to do with healthcare?
Deane Waldman writing at the Huffington Post.
Imagine you are a doctor walking down the street. You come upon a woman lying on the sidewalk possibly unconscious. Surrounding this woman are four people each loudly suggesting a different way to help. One is urging a candy bar, while another is promoting his unique, patented guaranteed cure for today only: $19.95 plus tax. A third is trying to resuscitate the woman, and the fourth is threatening her with a charge of public drunkenness.
The woman down on the sidewalk is Healthcare. Those offering to help - in essence doctors-without-licenses - are legislators, insurance executives, expert consultants, and regulators. You are the doctor - the person responsible for making the patient (healthcare) better. What should you do?
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Posted by: David Porter on April 16, 2008
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Category: Health Care
April 15, 2008
Environmental Justice, Public Health & Health Disparities
On Wednesday April 16, 2008, Dr. Sacoby Wilson will present:
“Environmental Justice, Public Health & Health Disparities”
Time: 9:30-11:00 am
Location: MetroHealth Medical Center - Rammelkamp Building - Room R240
All are welcome to attend.
For more information please contact Center Business Coordinator Cydney Johnson at 216-778-8484 or by email at cjohnson3@metrohealth.org.
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Posted by: David Porter on April 15, 2008
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Category: About Us
April 11, 2008
Chartbook of health disparities research
The Commonwealth Fund has published a chartbook of research related to health disparities.
The goal of this chartbook is to create an easily accessible resource that can help policy makers, teachers, researchers, and practitioners begin to understand disparities in their communities and to formulate solutions. Given the magnitude of the body of disparities research, we do not intend to create an exhaustive report that simply presents existing data. Rather we seek to prompt thinking about why these disparities may exist, and more importantly, what may be done to eliminate these gaps.
You can download the chartbook as a PDF or PowerPoint file at CommonwealthFund.org.
BONUS: Check back Monday for notes from Episode 3 of Unnatural Causes.
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Posted by: David Porter on April 11, 2008
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Category: Health Disparities; Health Inequities
April 10, 2008
Preview of Episode 3: The Latino Paradox
Tonight's episode of Unnatural Causes discusses the Latino paradox. Why is it that recent Mexican immigrants are healthier than the average American? Why does this health advantage disappear within a generation?
Here is a video preview of tonight's show. Locally it will be broadcast on WVIZ (PBS 25) at 10 p.m.
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Posted by: David Porter on April 10, 2008
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Category: Unnatural Causes
April 09, 2008
Addressing the Mental Health Disparities Evident in the African American and Latino Communities
"Addressing the Mental Health Disparities Evident in the African American and Latino Communities - A Grassroots Approach."
Presented by Marsha Mitchell Blanks, M.S.W., L.S.W. on March 14, 2008 as part of our Works in Progress series.
See this page for information on downloading and subscribing to our podcast.
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Posted by: David Porter on April 09, 2008
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Category: Audio / Video
Separate and unequal health care and the Republican response
The evidence is overwhelming that disparities in health outcomes exist. Nearly every day we post a link to a news story or scholarly article that looks at some aspect of health disparities.
The PBS special Unnatural Causes is helping to further push the discussion.
Given that income and education are huge factors in health outcomes not everyone is ready to accept that health is affected by factors more than just income and education.
Conservative radio talk show host Michael Medved argues that the disparity in life expectancy isn't due racism or social injustice but because those with more income and education make better choices:
Actually, the biggest reasons for wealthier people living longer lives reflect healthier habits: less smoking, better diet, more regular exercise, less divorce, fewer sexually transmitted diseases, and so forth. Educated and privileged people also get more and better information about protecting their own health, as well as more access to preventive care. The “inequalities” in life expectancy don’t indicate some profound injustice – in fact, it would be unjust and illogical if people who had created more wealth were unable to use those resources to secure better health outcomes.
It's unfortunate that Mr. Medved did not watch the PBS series prior to writing his commentary. From Episode 1 of the PBS special Unnatural Causes:
ADEWALE TROUTMAN: I’m clear that on the social gradient, that line that we talked about earlier, that I’m on the top of that line. I’m highly educated. I have a medical degree. I have several other degrees. I make good money. I live in a good neighborhood. But I know that according to the research, if you’re an African American, no matter what your social status, your socioeconomic status, your health outcomes are going to be worse than your white counterpart.
NARRATOR: African Americans die earlier and have higher rates than whites of many chronic diseases across the social gradient.
According to the PBS series, experiencing racism can be stressful. Chronic stress can have an adverse affect on the body's immune system making it more susceptible to illness and disease.
NARRATOR: Racial discrimination can be an added stressor, linked with high blood pressure, increased rates of infant death, coronary artery disease… Troutman knows what this can lead to. He authored a cornerstone study with former Surgeon General David Satcher on excess death among African Americans.
TROUTMAN: It was a national study and we found over 83,000 excess deaths per year in the African American community alone.
NARRATOR: 83,000 excess deaths each year. That’s the equivalent of a major airliner filled with Black passengers falling out of the sky every single day, every year.
It is not as simple as making better choices as Mr. Medved argues. It is about being treated as an equal and having equal access to care.
BONUS: RJ Eskow in an entry at the Huffington Post talks about the Republican response to the issue of unequal health care.
The Republican-dominated Florida State Senate is proposing to cut $803 million in health care financing for the low-income residents, the poor, and senior citizens -- a figure the Orlando Sentinel calls "staggering."
[John McCain] proposes to end tax benefits for employers providing health insurance. That would effectively scrap the current employer-funded system which, however imperfect, provides health coverage to millions of Americans today.
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Posted by: David Porter on April 09, 2008
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Category: Health Care; Health Disparities
April 07, 2008
Notes from Unnatural Causes - Program 2
Notes from the second episode of Unnatural Causes.
African-American women with a college degree have a higher infant mortality rate then white women who are high school drop outs.
African women who are immigrants to the U.S. and white women have similar infant outcomes. African-American women have premature babies at a much higher rate. This is evidence against a premature gene.
Social policies (war on poverty) helped to reduce disparity in infant outcomes. However, when the gov't started to cut back on social programs - infant mortality began to climb again in the African-American community.
Women who perceive they have been treated unfairly have a two-fold increase in low birth weight babies.
Chronic stress.
Chronic stress is associated with being a minority. Chronic stress can cause 'wear and tear' on the body's systems.
Chronic stress can lead to premature labor and/or low birth weight babies.
How to measure subtle racism?
One study looked at chronic diseases in women - how often do you think about your race? African-American women think about their race at least once per day.
Family Health and Birth Center
Immigrants may be healthier than U.S. citizens but life in the U.S. has an adverse affect on their health within one generation.
Latino paradox - Latinos with lower income had lower rates of psychiatric illness (and other illnesses) than whites with higher incomes. Perhaps due to family ties.
Social isolation influences the effects of aging. Staying socially connected improves health.
For each step along the wealth gradient - you have a corresponding step on the health gradient.
Second generation immigrants often lose their parents 'hopefulness.' This may lead to increased stress and poorer health outcomes.
First generation immigrants need to work long hours at low paying jobs. This may lead to a weaker family bond and poorer health outcomes in the second generation.
First generation immigrants have low rates of depression. Lifetime incident rates of depression rise after about 13 years in the U.S.
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Posted by: David Porter on April 07, 2008
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Category: Unnatural Causes
April 04, 2008
Physician diversity and health disparities
A new study by UCSF's Center for California Health Workforce Studies finds that the medical workforce in California is not representative of the state's population.
From the Sacramento Bee:
Latinos make up nearly a third of the state's population but only 5 percent of California's physician work force.
"It's not just a civil rights issue, but a public health issue," said Dr. Kevin Grumbach, director of the UCSF center. "Research shows clearly that having more minority physicians improves access to care for the U.S. population, because they are more likely to take care of patients who have no insurance or who are covered by Medi-Cal."
The study also found that while nearly 7 percent of the state's population is African American, only 3 percent of the state's doctors are.
And while Asians are overrepresented in medicine – making up 26 percent of the state's doctors but just 11 percent of the population – clear disparities remain for some Asian groups, including Samoans, Hmong/Laotians, and Cambodians.
Dr. Claire Pomeroy, dean of the UC Davis School of Medicine, argued that until the medical work force is more representative, health disparities along racial and ethnic lines will mount.
Bonus: Check back Monday for notes from the second program of Unnatural Causes.
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Posted by: David Porter on April 04, 2008
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Category: Diversity; Health Disparities
April 03, 2008
Medical humanities and health disparities
Thanks to a link from the current Health Wonk Review I noticed this post by Daniel Goldberg:
...work on health disparities, health policy, and the social determinants of health touches on the medical humanities in important ways. I think of it as evoking Plato's fundamental question: how shall we live? What kind of society do we want to practice being? I hope the answer to this question is in part, "a society that consciously works to ameliorate human suffering."
I've already bookmarked his Medical Humanities Blog.
BONUS - Live Smarter has an exhaustive list of some of the better Academic Medical blogs. Be sure to read the research area closely.
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Posted by: David Porter on April 03, 2008
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Category: Health Disparities
April 02, 2008
Health Disparities in the Asian-American Community
A new study out by the Kaiser Family Foundation reports that disparities exist within the Asian-American community.
The proportion of nonelderly who are uninsured varies widely, ranging from 31 percent of Koreans, 24 percent of Native Hawaiian and Pacific Islanders, and 21 percent of Vietnamese to 12 percent of Japanese and Asian Indians and 14 percent of Filipinos. In comparison, 12 percent of nonelderly non-Hispanic Whites are uninsured.
“It’s reasonably well known that African Americans and Latinos are much more likely to be uninsured than Whites, but I bet the public would be quite surprised to learn that certain Asian, Native Hawaiian and Pacific Islander groups also have such high uninsured levels. For this reason, these groups have a big stake in health reform debates,” said Kaiser Family Foundation President Drew E. Altman, Ph.D.
The full study can be found online at kff.org.
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Posted by: David Porter on April 02, 2008
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Category: Health Disparities