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Monday,
June 21, 2004
Congressional
Minority Caucus Panel
Hon.
Donna M. Christensen [bio]
Hon. Michael Honda [bio]
Hon.
Frank Pallone [bio]
Hon.
Hilda L. Solis [bio]
Suggested
Readings :
- Press
Release from the Office of the V.I. Congressional Delegate: Democrats
Announce Health Care Equality and Accountability Act of 2003 (Word
document; 31KB)
- House
and Senate Democrats announce principles for addressing racial and
ethnic health disparities (Word document; 28KB)
- Short
detailed summary of the Healthcare Equality and Accountability Act
HR 3459/ S 1833
(Word document; 2 pages; 35KB)
- Statements
by Senator Tom Daschle (South Dakota) (link),
Representative Nancy Pelosi (California) (press
release 10/21/2003) (press
release 4/4/2004)
- Summary
of the Healthcare Equality and Accountability Act HR 3459/ S 1833
(Word document; 33 pages; 156KB)
- List
of Institute of Medicine Reports on Minority Health
- Health
Care Equality and Accountability Act of 2003 (pdf; 432 pages;
779 KB)
- Congressional
Research Service Memorandum to Hon. Donna M. Christensen: The Healthcare
Equality and Accountability Act and the Closing the Health Care Gap
Act of 2004 (Word document; 300KB)
- Letter
to Honorable Bill Frist, MD and Honorable Tom Daschle
- Organizations
Supporting HR 3459 (Rep. Cummings)/ S 1833 (Sen. Daschle) The Healthcare
Equality and Accountability Act of 2004 (Word document; 34KB)
Tuesday, June 22, 2004
Is Health
Care Entitlement a Solution to the Problem of Health Disparities for American
Indians/Alaska Natives?
Jennie
R. Joe, Ph.D., M.P.H., M.A [bio]
Abstract
:
The
evidence for various racial and ethnic health disparities continues
to grow while promising innovative solutions to eliminate these disparities
continue to be defined. While the progress toward implementing these
solutions is slow, there appears to be consensus that any sustainable
solution to eliminating health disparities requires building alliances
and strengthening partnerships with the racial and ethnic communities
experiencing these problems.
The
need to improve the health status of American Indians/Alaska Natives
has been a longstanding goal pursued by tribal communities, their
advocates, and the federal Indian Health Service. One objective to
achieve this goal has involved the realization of self-determination,
a policy change that has encouraged tribes to take over management
of their own health care delivery systems. Unlike other minority populations
in the United States, American Indians and Alaska Natives have a unique
government-to-government relationship with the federal government,
an arrangement that often serves as the only mechanism to bring about
policy change and/or to bring additional resources to help create
change. At the present, tribes are supporting the reauthorization
of key health legislation that includes a provision to initiate a
study to examine health care entitlement. It is against this backdrop
that this presentation will discuss the key health disparities faced
by American Indians/Alaska Natives, the funding of health care, and
the congressional route advocated for resolving some of these health
disparities.
Learning Objectives:
- Gain
an understanding of how American Indians/Alaska Natives receive their
health care as well as the role of the federal government
- Gain
some knowledge about the historical and political history that has
impacted the health disparities faced by American Indians/Alaska Natives.
- Gain
some insight into solutions being tried to target some specific preventable
health problems
Bibliographic Citations :
- Dixon,
Mim and Yvette Roubideaux (eds). (2001). Promises to Keep: Public
Health Policy for American Indians and Alaska Natives in the 21st
Century. Washington, DC: American Public Health Association. For updates
on the reauthorization progress for the Indian Health Care Improvement
Act, (H.R. 2440), go to the website of the National Indian Health
Board: www.nihb.org
- Joe,
Jennie R. (2003). The Rationing Healthcare and Health Disparity for
American Indians/Alaska Natives. Pp.528-551 in Unequal Treatment:
Confronting Racial and Ethnic Disparities in Healthcare. Washington,
DC: Institute of Medicine. National Academy Press.
- Indian
Health Service (2000-2001). Trends in Indian Health. Rockville, Md:
USDHHS. USPHS, Indian Health Service.
- Meriam,
Lewis (1928). The Problem of Indian Administration: A Survey made
at the Request of the Honorable Hubert Work, Secretary of Interior.
Baltimore, MD: Johns Hopkins University Press (published for the Brookings
Institution). February 21.
- Office
of Technology Assessment (OTA). (1986). Indian Health Care. Washington,
DC: US Government Printing Office.
- Rhodes,
Everett R. (ed). (2000). American Indian Health: Innovations in Health
Care, Promotion, and Policy. Baltimore: Johns Hopkins University Press.
Wednesday, June 23, 2004
Neighborhoods
and Health Disparities [slides] (will be posted at about 12:30pm EDT)
Gilbert
C. Gee, Ph.D. [bio]
Abstract
:
The
goal of this presentation is to provide a framework for understanding
how neighborhoods may explain ethnic disparities in health. We begin
with a brief overview of the patterns of residence and settlement
by ethnicity, including a discussion of the major concepts related
to these patterns (segregation, ethnic enclaves) and the processes
that may have led to their development (e.g. institutionalized racism).
We then examine the relationship between residence and health, focusing
in particular on the neighborhood processes that may lead to differential
outcomes by ethnicity. In particular, we will focus on neighborhood
resources, community stressors, and environmental justice. Finally,
we will consider the extent to community redevelopment provides a
potential avenue to shape the health of all communities and a way
to eliminate health disparities.
Learning Objectives:
- Understand
how the psychosocial conditions of neighborhoods may contribute to
health.
- Examine
how patterns of residential location vary by race.
- Articulate
the relationship between residential segregation, neighborhood risk
and resiliency, and health.
Bibliographic Citations :
- Acevedo-Garcia,D.
(2003) Future directions in residential segregation and health research:
a multilevel approach. American Journal of Public Health, 93, 215-221.
- Diez-Roux,A.V.
(2000) Multilevel analysis in public health research. Annual Review
of Public Health, 21, 171-192.
- Gee
GC. (2002) A Multilevel analysis of the relationship between institutional
and individual racial Discrimination and health status. American Journal
of Public Health. 92, 615-623
- Geronimus,A.T.
(2000) To mitigate, resist, or under: addressing structural influences
on the health of urban populations. American Journal of Public Health,
90, 867-872.
- LaVeist,T.A.
(1993) Segregation, poverty, and empowerment: health consequences
for African Americans. Milbank Quarterly, 71, 41-64.
- Massey,D.
& Denton,N.A. (1993) American Apartheid: Segregation and the Making
of the Underclass. Harvard University Press, Cambridge.
- Northridge
ME, Sclar ED, Biswas P. (2003) Sorting out the connections between
the built environment and health: a conceptual framework for navigating
pathways and planning healthy cities. Journal of Urban Affairs, 80,
556-568.
- Pastor,M.,
Sadd,J. & Hipp,J. (2001) Which came first? Toxic facilities, minority
move-in, and environmental justice. Journal of Urban Affairs, 23,
1-21.
- Schulz,
A.J., Williams, D.R., Israel, B.A., Lempert, L.B. (2002). Racial and
spatial relations as social determinants of health in Detroit. Milbank
Quarterly, 80(4), 677-707.
- Williams,D.R.
& Collins,C.A. (2001) Racial residential segregation: a fundamental
cause of racial disparities in health. Public Health Reports, 116,
404-416.
Foundations for Sexual Minority Health [slides] (will be posted at about 12:30pm EDT)
Judith C. Bradford, M.A., Ph.D. [bio]
Abstract :
The health of sexual minority individuals and communities became a concern for public health in the United States when “persons defined by sexual orientation” were included in Healthy People 2010 as one of six groups experiencing health disparities and barriers to healthcare access. LGBT professional organizations and researchers worked with local, state, and federal government representatives to develop a common understanding of the health concerns and needs of sexual minorities, resulting in the initiation of the emerging field of lesbian, gay, bisexual, and transgender (LGBT) health. Remarkable progress has been made during the past five years to establish a unifying conceptual framework for this work and to develop an organizational infrastructure to address the multi-level challenges that must be overcome in order sexual minorities to have access to quality healthcare. The purpose of this presentation is to provide a framework for tackling several big questions: who are sexual minority persons and what are their healthcare needs? what factors influence the health of sexual minorities? how can public health respond? how do we set priorities, and what are the most important opportunities and challenges?
Learning Objectives:
- Describe the estimated number and distribution of sexual minorities in the United States, how these estimates are derived, and how to critically assess their utility.
- Identify the most significant health concerns and barriers to healthcare access of LGBT persons, within the context of health disparities.
- Use a social ecology model to discuss social, institutional, and policy-related contexts influencing the quality of life that sexual minorities can expect to achieve.
- Describe the initiation and ongoing development of a public health response to the healthcare needs of lesbian, gay, bisexual, transgender (LGBT) and intersex persons.
- Identify opportunities and challenges in sexual minority public health
Thursday,
June 24, 2004
The
Latino mortality paradox revisited: Is acculturation bad for your health? [slides]
Ana
Abraido-Lanza, Ph.D. [bio]
Abstract
:
There
is a great body of evidence on the inverse relationship between socioeconomic
status and morbidity and mortality. Relative to non- Latino whites,
Latinos in the United States have a worse socioeconomic status profile,
but a lower all-cause mortality rate. This paradox has stimulated
various hypotheses, such as selective migration of healthier individuals.
This presentation will provide a general overview of hypotheses proposed
to explain the Latino mortality paradox, as well as research findings
concerning the paradox. Particular emphasis will be placed on the
health behaviors and acculturation hypotheses, which posit that: (1) Latinos
have more favorable health behaviors and risk factor profiles than
non-Latino whites, and (2) Health behaviors and risk factors
become more unfavorable with greater acculturation. An overview of
concepts and theories on acculturation and health will be provided.
Research findings will be highlighted from studies that test theoretical
models concerning the association between acculturation and various
health behaviors (e.g., breast cancer screening).
Learning
Objectives:
- Discuss the main hypothesis concerning the Latino mortality paradox
- Analyze evidence concerning the paradox
- Describe key issues in acculturation theory as it concerns the health
of Latinos
Bibliographic
Citations :
- Abraído-Lanza,
A.F., Dohrenwend, B.P., Ng-Mak, D.S., & Turner, J.B. (1999). The
Latino mortality paradox: A test of the "salmon bias" and
healthy migrant hypotheses. American Journal of Public Health,
89, 1543-1548.
- Clark
L, Hofsess L. (1998). Acculturation. In S. Loue (Ed.), Handbook
of Immigrant Health. New York, NY: Plenum Press; 1998,37-59.
- LaFromboise,
T., Coleman, H.L.K., & Gerton, J. (1993). Psychological impact
of biculturalism: Evidence and theory. Psychological Bulletin,
114, 395-412.
- Chun,
K.M., Balls Organista, P. & Marín, G. (2003). Acculturation:
Advances in theory, measurement and applied research. Washington,
DC: American Psychological Association.
Racial
Disparities in Prescription Drug Utilization: An Analysis of Beta-Blocker
and Statin Use Following Hospitalization for Acute Myocardial Infarction [slides]
Jerome
Wilson, M.A., Ph.D. [bio]
Abstract
:
OBJECTIVE:
To assess the whether the use of beta-blockers and statins following
hospitalization for an acute myocardial infarction (MI) varies by
race/ethnicity among Medicaid recipients.
METHODS: This retrospective study used administrative claims and eligibility
information from a 20% random sample of California Medicaid recipients.
We selected adult patients who were hospitalized for acute MI between
January 1, 1998 and December 31, 2000. Study patients were required
to be eligible for medical and pharmacy benefits for six months prior
to their MI to three months following the event. Patients were excluded
if they did not have a known race/ethnicity (i.e., white, African
American, Hispanic, Asian) recorded. Medical claims were used to assess
the burden of comorbidity in the six months prior to hospitalization.
Pharmaceutical claims were used to identify beta-blocker and statin
drugs dispensed following the MI hospitalization. Logistic regression
was used to assess the relation between race/ethnicity and the likelihood
of use of beta-blockers and statins, respectively, adjusting for other
potential differences in patient characteristics and comorbidity.
RESULTS: We identified 2,069 patients who were hospitalized for MI
who met the cohort inclusion criteria. They had a mean age of 71 years
and 54% were female. Fifty-eight percent were white, 23% were Asian,
14% were African American, and 5% were Hispanic. The average Charlson
comorbidity score (excluding MI) was 1.8 (±1.3). Approximately
one-half of patients were dispensed beta-blockers and one-third received
statins in the 90 days following hospitalization. Compared with whites,
African-American patients were significantly less likely to receive
either beta-blockers (adjusted odds ratio 0.71; 95% CI 0.55 to 0.93)
or statin therapy (OR: 0.66; 0.49 to 0.88), and hispanics were less
likely to be dispensed statins (OR: 0.52; 0.32 to 0.85). Asian patients
did not differ from whites in the likelihood of receiving either type
of therapy.
CONCLUSIONS: In this Medicaid population, a relatively low proportion
of patients were dispensed beta-blocker or statin drugs following
an MI hospitalization. African-Americans, and to a lesser extent,
Hispanics, were the least likely to receive treatment.
Learning Objectives:
- Recognize
that differential dispensing of prescription drugs for certain acute
and chronic conditions may contribute to observed health disparities.
- List
the two classes of drugs that should be dispensed to patients after
hospitalization for an acute myocardial infarction.
- Articulate
which race/ethnic groups are more or less likely to receive beta-blocker
and/or statin therapy following a hospitalization for an acute myocardial
infarction.
- Identify
the top four comorbidities that are likely to be associated with Medicaid
patients who have been hospitalized with an acute myocardial infarction.
- List
the factors that are associated with decreased likelihood of receiving
a bata-blocker or statin after an inpatient stay for an acute myocardial
infarction.
Bibliographic
Citations :
- Ding
J, Diez Roux AV, Nieto FJ, et al. Racial disparity in long-term mortality
rate after hospitalization for myocardial infarction: the Atherosclerosis
Risk in Communities study. Am Heart J 2003 Sep;146(3):459-64.
- Giles
WH, Anda RF, Casper ML, Escobedo LG, Taylor HA. Race and sex differences
in rates of invasive cardiac procedures in US hospitals: Data from
the National Hospital Discharge survey. Arch Intern Med 1995 Feb;155(3):318-24.
- Peterson
ED, Wright, SM, Daley J, Thibault GE. Racial variation in cardiac
procedure use and survival following acute myocardial infarction in
the Department of Veterans Affairs. JAMA 1994 Apr;271(15);1175-80.
- Qureshi
AI, Suri MF, Guterman LR, Hopkins LN. Ineffective secondary prevention
in survivors of cardiovascular events in the US population: Report
from the Third National Health and Nutrition Examination Survey. Arch
Intern Med 2001 Jul;161(13):1621-8.
- Ryan
TJ, Antman EM, Brooks NH, et al. 1999 update: ACC/AHA guidelines for
the management of patients with acute myocardial infraction: A report
of the American College of Cardiology/American Heart Association Task
Force on Practice Guidelines (Committee on Management of Acute Myocardial
Infraction). Available at: http://www.acc.org. (Accessed April 2004).
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