Topic Page for Health Disparities
Meredith Minkler Lecture
Nationally reknown scholar Meredith Minkler, DrPH, MPH will present “Collaborative Research with Communities: Challenges and Opportunities for Addressing Health Disparities” in room R240 of the Rammelkamp Building at MetroHealth Medical Center on October 15 at 12:30 p.m.
Dr. Minkler is Professor and Director of Health and Social Behavior at the School of Public Health, University of California, Berkley. She has 30 years experience in community partnerships, community based participatory research and work with diverse community groups. She has published over 100 articles, peer-reviewed journals and 7 books. Please RSVP to Ayella Shams at 216-778-8481 or ashams@metrohealth.org.
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Posted by: David Porter on October 14, 2008
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Category: Health Disparities; Heath Inequities
Report finds significant child health disparities
Ohio Health Policy is reporting on a new by the Robert Wood Johnson Foundation:
"The bad news is that we have these very large gaps, which can be thought of as shortfalls in the health potential of our children," said lead author Dr. Paula Braveman. "But the patterns we see tell us that these gaps are fixable if we as a society put our will to the task."
The Health Care Blog has an excellent write up on the topic.
You can find the study at rwjf.org.
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Posted by: David Porter on October 14, 2008
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Category: Health Care; Health Disparities; Health Inequities; children
JAMA reports on racial disparities in breast cancer treatment
From JAMA:
A recent analysis presented at the symposium by researchers at the M. D. Anderson Cancer Center in Houston revealed that black women are less likely than white women to receive radiation therapy after lumpectomy, which is the standard of care. The study, which is the first to look at radiation therapy rates on a national scale and to compare differences among US regions, also showed that radiation rates after lumpectomy in general are lower than they should be.
Another study sought to identify the reasons for higher mastectomy rates in rural areas. A long-held belief is that mastectomies are more common among women who live in rural areas because they do not have the same access to postlumpectomy radiation therapy as urban women. However, this study found that women in rural and urban areas have equivalent rates of radiation therapy following breast cancer surgery.
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Posted by: David Porter on October 09, 2008
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Category: Breast Cancer; Health Care; Health Disparities; Health Inequities
African Americans have a dramatically worse prognosis for head and neck cancer
In a study published this week in the journal Cancer researchers report that African-Americans with head and neck cancers have a shorter survival time than whites (21 months vs. 40 months) and that the difference "is not explained completely by demographics, comorbid conditions, or undertreatment because poor outcomes continued to be observed after correcting for these factors. Earlier diagnosis, particularly in those from low SES groups and among AA patients, is needed to improve outcomes."
MedPage Today has a good review of the article.
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Posted by: David Porter on October 08, 2008
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Category: African-American Health; Cancer; Head and Neck; Health Disparities; Heath Inequities
Health disparities in Erie PA
From GoErie.com:
In 2000, the study reported, Erie County's population was 93.6 percent caucasian, 6.1 percent black and 2.2 percent Hispanic. Yet the poverty rate for children under 18 was 46.6 percent for the black population, compared with 11.4 percent for whites. Erie County's poverty rate for children was higher than both the Pennsylvania and national rates.
The percentage of births to single women and to teens (including young teens) in the black community in Erie was also considerably higher when compared with the majority population. The percentage of females who received prenatal care was lower for black women than for whites in Erie County. The mortality rate for black babies was also higher compared to white babies.
Those statistics pointed to a gap in health care from the very start of life.
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Posted by: David Porter on October 03, 2008
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Category: Health Disparities; Health Disparities News; Heath Inequities
Racial health disparities in Akron
Tracy Wheeler writing in the Akron Beacon Journal:
Statistics supplied by the Akron Health Department show that, unlike whites, blacks gain no health benefits by moving up the economic ladder. Blacks living in neighborhoods above the poverty line lived no longer than blacks in impoverished areas, dying at essentially the same age — 67.1 years compared with 66.8 years.
By comparison, though, whites living in Summit County's more well-to-do neighborhoods live to an average age of 76.4, compared with just 67.1 for blacks in the same type of neighborhoods — a gap of 9.3 years.
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Posted by: David Porter on September 12, 2008
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Category: Health Disparities; Health Inequities; Social Determinants of Health; racial differences
Don’t expect a long life living in W.Va.
From the Register-Herald:
“If you include both men and women, only four counties in [West Virginia] have a life expectancy rate above the national average,” [Perry] Bryant said. “If you look only at women, no county in the state is above the national average.”
In an audio report available at West Virginia Public Broadcasting we learn about one case of childhood obesity:
The rise in diabetes is tied to a rise in obesity. Dr. Paul Little, medical director of Tug River Medical Center in McDowell County, has one eight-year-old patient who already weighs 160 pounds.
“He goes to McDonalds every single day,” Little said. “And we try to educate parents that’s not good. And they say, he cries, he carries on. So we say, let the kid cry and carry on. You need to start to do this and this, because here he is, eight years old, and he’s already obese.”
Little said the boy is just following his father’s example.
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Posted by: David Porter on September 05, 2008
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Category: Health Disparities
Health care inequality and abortion rates
In a commentary that appears in the Philadelphia Inquirer Melissa Gilliam writes:
Behind virtually every abortion is an unintended pregnancy. African American women have higher abortion rates than their white peers because they have much higher rates of unintended pregnancy - three times higher than those of white women. In other words, there is no need to resort to far-flung conspiracy theories to explain the higher abortion rate among black women.
But there's more to the story. Across the board, African Americans often have worse sexual- and reproductive-health outcomes than people from other racial groups. For example, we experience much higher rates of sexually transmitted infections. These disparate rates reflect broader health disparities that can be seen in high rates of diabetes, obesity, heart disease or cancer.
The root causes are manifold: a long history of discrimination; lack of access to high-quality, affordable health care; too few educational and professional opportunities; unequal access to safe, clean neighborhoods; and, for some African Americans, a lingering mistrust of the medical community.
EXTRA: In a terrific blog entry, Rural Doctoring talks about a hair on the back of her neck.
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Posted by: David Porter on August 12, 2008
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Category: African-American Health; Health Disparities; Health Inequities; Women's Health
Money and beauty to the left - skin diseases and insurance to the right
From NYTimes.com:
Like airlines that offer first-class and coach sections, dermatology is fast becoming a two-tier business in which higher-paying customers often receive greater pampering. In some dermatologists’ offices, freer-spending cosmetic patients are given appointments more quickly than medical patients for whom health insurance pays fixed reimbursement fees.
A study published last year in The Journal of the American Academy of Dermatology found that dermatologists in 11 American cities and one county offered faster appointments to a person calling about Botox than for someone calling about a changing mole, a possible sign of skin cancer.
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Posted by: David Porter on July 28, 2008
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Category: Health Care; Health Care; Health Disparities; Healthcare; Heath Inequities; Skin Cancer
American inequality highlighted by 30-year gap in life expectancy
From The Independent:
The American Human Development Index has applied to the US an aid agency approach to measuring well-being – more familiar to observers of the Third World – with shocking results. The US finds itself ranked 42nd in global life expectancy and 34th in survival of infants to age. Suicide and murder are among the top 15 causes of death and although the US is home to just 5 per cent of the global population it accounts for 24 per cent of the world's prisoners.
Despite an almost cult-like devotion to the belief that unfettered free enterprise is the best way to lift Americans out of poverty, the report points to a rigged system that does little to lessen inequalities.
"The report shows that although America is one of the richest nations in the world, it is woefully behind when it comes to providing opportunity and choices to all Americans to build a better life," the authors said.
You can visit the website of the American Health Development Index at measureforamerica.org.
EXTRA: Chip Bok illustrates one possible effect of kids taking statins.
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Posted by: David Porter on July 17, 2008
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Category: Health Disparities; Health Inequities; children; prescriptions; statins
Racial and Ethnic Differences in Asthma Prevalence
The Kaiser Network is linking to a new study that talks about asthma and how exposure to different housing environments contributes to disparities.
If you click on this link you can download a pdf of the original article for free. Act fast - I have no idea how long this will be available.
EXTRA: 'Cool Whip' is taking the week off but will return next week. You can always check out archives of the comic at our 'Cool Whip' page.
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Posted by: David Porter on July 02, 2008
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Category: Health Disparities; asthma; housing
Disparities in colon cancer screening rates
From EurekAlert:
Blacks and Hispanics appear less likely to undergo colorectal cancer screening than whites because of socioeconomic, health care access and language barriers, according to a report in the June 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. However, other factors may contribute to screening disparities experienced by Asians.
You can find the full study at the Archives of Internal Medicine.
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Posted by: David Porter on June 24, 2008
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Category: Cancer; Colorectal Cancer; Health Disparities; Health Inequities; Screening Rates
Women with diabetes and the control of risk factors
From Medical News Today:
"Our study shows that in patients with diabetes there is a clear disparity between men and women in the control and treatment of important modifiable risk factors for cardiovascular disease," Gouni-Berthold said. "Women have worse control of their blood pressure, blood sugar and cholesterol levels compared to men and are given cholesterol-lowering medications less often."
BONUS: A doctor in Maine opens up a no-insurance practice.
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Posted by: David Porter on June 16, 2008
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Category: Health Disparities; diabetes; gender differences; insurance; risk factors
Congressional Testimony on Health Disparities
Congresswoman Solis testifies before the House Ways and Means Subcommittee on Health regarding health disparites.
Part I
Part II
Transcript at the Congresswoman's website.
BONUS: The Lancet will publish a theme issue devoted to social determinates of health. This special issue will be published on November 8, 2008. More information at The Lancet. Subscription is required.
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Posted by: David Porter on June 13, 2008
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Category: Health Care; Health Disparities; Medicare; interpreter advocates; racial differences
Health disparities and race in diabetes care
From NYTimes.com:
As researchers ponder growing evidence that blacks have worse outcomes than whites in the treatment of chronic disease, they often theorize that members of minorities suffer disproportionately from poor access to quality care. Now a new study of diabetes patients has found stark racial disparities even among patients treated by the same doctors.
From the Archives of Internal Medicine:
White patients (N = 4556) were significantly more likely than black patients (N = 2258) to achieve control of HbA1c (47% vs 39%), LDL-C (57% vs 45%), and blood pressure (30% vs 24%; P < .001 for all comparisons). Patient sociodemographic factors explained 13% to 38% of the racial differences in these measures, whereas within-physician effects accounted for 66% to 75% of the differences. Physician-level variation in disparities was not associated with either individual physicians' overall performance or their number of black patients with DM.
And from an editorial which also appears in the Archives:
What will it take to close the gap for one of the most important chronic disease clusters affecting all nations? The bottom line is that public reporting on performance has had an important impact on processes of care under the control of a physician or health system (ordering tests), but our collective knowledge of which strategies are most effective for which patients is substantially underdeveloped compared with our knowledge of scientific evidence. In other words, we know and understand far more about what to do than who specifically needs what care and how to do it consistently and reliably.
Bonus: Did you know that flip flops might be bad for you?
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Posted by: David Porter on June 10, 2008
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Category: Health Disparities; Health Inequities; diabetes; health care access; racial differences
Health Disparities Podcasts
Project HYPE - Voices of High Blood Pressure Revealed through a Community Lens.
This video provides an excellent overview of the Photovoice component of Project HYPE. It is excellent viewing for those interesting in Community Based Participatory Research (CBPR.)
Download link (video podcast)
"Four Recommendations For Preventing Diabetes and Obesity"
Presented by Roxanne B. Sukol MD, MS. University Hospitals. Hosted by Cleveland State University's Center for Health Equity.
Download link (video podcast)
Community Based Participatory Research - Are the scales balanced?
Presented by Maghboeba Mosavel, PhD, Karen Tabb, MSW, Catherine Oakar, BA, Ayella Shams, BS.
Dr. Mosavel and her team discuss the challenges, rewards, lessons learned, and 'what's next' for their CBPR projects.
Download link (audio and slides)
Download link (audio only)
"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.
Download Link (Video Podcast)
"Elder Abuse: Framing the Issue."
Presented by Georgia Anetzberger, PhD, ACSW, LISW. Hosted by Cleveland State University's Center for Health Equity.
Download Link (Video Podcast)
"Using the Primary Socialization Theory to Predict Adolescent Substance Use and Sexual Risk Taking Behaviors." Shelley A. Francis, MPH, DrPH, CHES.
Download Link (Video Podcast)
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Posted by: David Porter on June 05, 2008
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Category: Elder Abuse; Health Disparities; Mental Health; Podcasts; Primary Socialization Theory; Risk Taking; Video Podcasts; community based participatory research
Stroke risk in women
An MSNBC.com article talks about the disparity in risk of stroke between men and women.
The risk [of stroke] surges between ages 45 and 54. In those years, women are more than twice as likely as men to have strokes. And at every age, strokes are harder on women — they're more likely than men to wind up physically and mentally impaired.
On average, women get to the emergency room an hour later than men when a stroke hits, partly because stroke isn't on their mental checklist of ER-worthy dangers. And when they reach the hospital, it takes women about an hour longer to be examined by a neurologist.
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Posted by: David Porter on June 04, 2008
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Category: Health; Health Disparities; Health Inequities; Women's Health; gender disparities; stroke
Health disparities in India
The International Herald Tribune has a story posted that speaks to health disparities in India. The article contrasts the care provided by two very different hospitals.
Wockhardt is a state-of-the-art private hospital that provides 5-Star service. Patients have private rooms overlooking gardens. Cable TV and computers are just a few steps away. There is even ice cream in a mini fridge in case of an afternoon craving.
The government run hospital, Bowring, is a different story. Patients are brought by family members to a place with no dialysis machines, no ventilators, and no ICU. Dinner is a few slices of white bread on a plate.
One of the issues discussed in the article is that of utilization. The private hospital has plenty of life saving equipment that goes unused. So while patients die from lack of dialysis at Bowring dialysis machines sit idle at Wockhardt.
At Bowring, one of the young doctors, named Harish, said a ventilator and a dialysis machine would have allowed him to keep half of his patients alive. The most severe case, Mohammed Amin, was breathing with the aid of a hand pump that his wife squeezed silently.
Harish sent the relative of one man to get blood tests done at the nearest private hospital; there was no equipment to do the test here.
According to the article a survey of Indian households found that across social classes people prefer private care over government facilities. Why? Because of quality.
The government run health centers in India are understaffed. 53% of pediatric positions are not filled. Government doctors earn less than private doctors and aggressive recruiting by private hospitals allow them to lure physicians who have worked and trained abroad.
Ironically, the luxurious private hospitals in India are bargains for Americans looking to save money. One American, Robin Steeles, paid $20,000 to have a mitral valve repaired. According to the article, that's about 10% of what it would cost in the U.S.
EXTRA: Just noticed that the Connecticut Health Policy Project has a blog focused on health care in Connecticut. They've been added to my RSS feed.
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Posted by: David Porter on June 03, 2008
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Category: Health Disparities; Socioeconomic Status; class differences; health care access; icu
Racial disparity in amputation rate
From UPI:
African-American neighborhoods have an incidence rate of amputations from diabetes five times higher than that of white neighborhoods, researchers say.
The study, published in the Journal of Vascular Surgery, found that in the South and West sides of Chicago, African-Americans comprised less than 15 percent of the population, but accounted for 27 percent of all amputation discharges for 33,775 patients at 171 hospitals during the study period of 1987 to 2004.
The study can be found in the Journal of Vascular Surgery.
EXTRA: Aggravated Doc Surg is not happy with JCHAO.
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Posted by: David Porter on June 02, 2008
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Category: African-American Health; Amputations; Health Disparities; diabetes; racial differences
Pilot program to offer free health care to illegal immigrants
Massachusetts is initiating a pilot program which will provide free health insurance to 50 frequent users of the state's Safety Net Pool. If the program is effective it may be expanded statewide.
You can read the article at the Metro West Daily News. Steer clear of the comment section if you wish to avoid vitriol this morning.
EXTRA: The Seattle Times is reporting that more treatment isn't always better treatment:
When it comes to hospital health care, more isn't necessarily better, says a Consumer Reports analysis of care given at hospitals around the country.
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Posted by: David Porter on May 30, 2008
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Category: Health Care; Health Disparities; immigrants; insurance
Race disparities in the intensive care unit
Our own J. Daryl Thornton, M.D., M.P.H,(pdf biosketch) presented new research on May 21st at the American Thoracic Society’s 2008 International Conference in Toronto.
Based on interviews with more than 1,200 ICU physicians at five major medical centers across the country, researchers conclude that physicians are less comfortable discussing end-of-life issues and do it less frequently with African-American patients and their families than with Caucasian patients and families.
You can read the entire press release below the fold or check out the Washington Post article.
From EurekAlert!:
ATS 2008, TORONTO—An important study raises concern about the way intensive care physicians approach patients and families facing serious end-of-life medical decisions. Based on interviews with more than 1,200 ICU physicians at five major medical centers across the country, researchers conclude that physicians are less comfortable discussing end-of-life issues and do it less frequently with African-American patients and their families than with Caucasian patients and families.
J. Daryl Thornton, M.D., M.P.H., of the Center for Reducing Health Disparities at MetroHealth Medical Center in Cleveland and Case Western Reserve University (CWRU), an assistant professor at CWRU, will present the findings at the American Thoracic Society’s 2008 International Conference in Toronto on Wednesday, May 21.
One in five Americans will die in the ICU or shortly after a stay there, and, frequently, their deaths follow a decision made by families to withdraw life-sustaining therapies. “That is why it is so important that physicians are comfortable delivering difficult and sometimes complex diagnoses, potential outcomes and prognoses to patients and families in the ICU,” said Dr. Thornton. “Our study suggests there may be some underlying biases and/or discomfort among physicians, which impacts their ability to have these difficult conversations with families.”
“We had previously shown that ICU physicians, when predicting likelihood of survival of their patients, are less likely to predict that their African-Americans patients will survive,” he continued. “Ironically, those African-Americans were more likely to survive. These two studies, taken together, suggest we need to collect more information about what impacts the prognostic decisions by physicians, and whether any underlying biases are influencing the way they communicate with patients and families.”
The researchers examined data from the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT), which was conducted between 1989 and 1994 involving a group of 9,105 seriously ill hospitalized patients and their 1,241 physicians at five major medical centers across the country. On the third day of the study, physicians were asked if they had had prognostic conversations with their patients or their patients’ surrogates (the person appointed by the patient to make their medical decisions).
Patients or their surrogates were also interviewed at the same time to assess their functional level two weeks prior to being admitted to the hospital, income, race, age and insurance status.
After adjusting for a variety of potentially confounding factors, such as severity of illness and insurance status, physicians reported having had prognostic conversations with 58 percent of their white patients, but only 41 percent of their African-American patients. Furthermore, physicians were less than half (43 percent) as likely to report feeling comfortable during those conversations with their African-American patients. This was true regardless of the actual prognosis.
“We acknowledge that this study uses data that is dated. The findings should be replicated and would be an important area for health disparities research—understanding the effects of physician biases on decision-making, communication and patient outcomes in the ICU,” said Dr. Thornton. “By having a detailed understanding of the components of this intricate relationship, interventions can be implemented to enable the provision of more culturally sensitive and equitable care in the ICU.”
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Posted by: David Porter on May 23, 2008
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Category: Health Disparities; Healthcare; emergency care; icu
Huge gap in mortality rates among those with CKD
Using data from a population based survey of community dwelling individuals, Dr. Rajnish Mehrotra and his team found that those with chronic kidney disease (CKD) had an all-cause mortality rate twice that of those with normal kidney function. Also, among those with CKD, blacks who were under 65 years old were 78% more likely to die than their white counterparts.
From EurekaAlert.org:
Dr. Mehrotra and his team conclude that their findings may explain the lower mortality rates observed among blacks with advanced kidney disease. As a result of the higher risk for death in the early stage of chronic kidney disease, only healthier blacks are surviving and developing later stages of chronic kidney disease.
The study will appear in an upcoming issue of the Journal of the American Society of Nephrology.
EXTRA: Ohio Health Policy Review talks about how expensive open enrollment is for a high risk uninsured person. A single 40 year old can expect to pay $20,000 for a year of insurance.
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Posted by: David Porter on May 20, 2008
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Category: Health Disparities; ckd; insurance; kidney disease; racial differences
Disparities in blood sugar control
From Reuters:
In general, the study found that black patients had a higher average blood sugar level than white patients did one year after starting drug therapy. They were also somewhat less likely to comply with their medication regimen, which was gauged by how often the patients refilled their prescriptions.
This did not, however, fully explain black patients' poorer blood sugar control, the researchers report in the journal Diabetes Care.
Exactly what does explain the racial gap remains an open question, according to the researchers, led by Dr. Alyce S. Adams.
One possibility, they suggest, is that African Americans tend to have more severe diabetes by the time they are diagnosed and treated. So they may need more intensive treatment off the bat, including higher medication doses.
The full study can be found at the journal Diabetes Care.
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Posted by: David Porter on May 16, 2008
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Category: Health Disparities; blood sugar
Racial disparities in diabetes control
DIABETES CONTROL may be more challenging for Hispanics than for non-Hispanic whites, a meta-analysis suggests.
Researchers found that hemoglobin A1c (HbA1c) levels are higher in Hispanics than non-Hispanic whites, with an overall mean HbA1c difference of 0.5%. The reasons for the disparity in HbA1c levels are not known, but plausible explanations include differences in biology, access to care, insurance status, and diabetes treatment adherence
BONUS: New York City started issuing citations to restaurants that did not have calories posted on their menus. See NYTimes.com for more info.
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Posted by: David Porter on May 07, 2008
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Category: Health; Health Disparities; racial differences
Disparities in nutrition among poor women
From Reuters:
Researchers found that among 603 mothers of children in Head Start programs in Alabama and Texas, diets tended to be too low in important nutrients. But Hispanic mothers did generally get more fruits and vegetables than white and African-American mothers did, and a lower percentage of their daily calories came from fat.
On average, the study found, Hispanic women consumed what health experts consider an adequate amount of fruits and vegetables -- 4.6 cups per day, based on detailed dietary questionnaires.
In contrast, white and black women averaged between 2 and 3 cups per day, the researchers report in the Journal of the American Dietetic Association.
The study can be found in the Journal of the American Dietetic Association.
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Posted by: David Porter on May 02, 2008
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Category: Head Start; Health Disparities
Access barriers and disparities in the disabled
Posting as part of Blogging Against Disablism Day.
In a 2007 commentary that appeared in JAMA the authors list previous research that demonstrates how disabilities affect treatment.
- Women with major mobility problems were less like to have received a PAP test in the prior three years than women without major mobility issues.
- 45% of women with major mobility issues reported have a mammogram in the previous 2 years vs. 64% of women without mobility issues.
- In a study of Los Angeles County residents with disabilities those who were black, had lower incomes, and were more severely disabled were more likely to report difficulties in accessing clinicians offices.
- In women with breast cancer those who were disabled were less likely to receive radiotherapy following breast-conserving surgery.
The authors close with a call to reduce structural barriers and emphasize form and function:
As health care facilities managers renovate structures, construct new buildings, and purchase equipment and furnishings, they should remember legal requirements as well as health care’s therapeutic mission. Environments with barriers will not foster healing and could endanger the safety and experiences of patients and employees. Form follows function. Healing, not handicapping, should guide design of environments to ensure health care access for all persons.
BONUS: The Medical Humanities Blog has the latest Health Wonk Review up. There are even a few Seinfeld references in the mix.
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Posted by: David Porter on May 01, 2008
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Category: Health Disparities
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
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
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
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
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
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
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
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
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
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
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
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
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
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.