Health Disparities of People with Disabilities

Report
Health
Disparities of
People with
Disabilities;
Influence of
Race and
Ethnicity
NCIL Conference
Presenters;
Dara Baldwin
Stanley Holbrook
Health Disparities
 Overall, people with disabilities have been
reported to experience fair or poor health,
approximately four times more than their nondisabled peers. In addition, there is a
disproportionate percentage of people with
disabilities that experience the social
determinants of poor health
Health Disparities
• In addition, there is a disproportionate
percentage of people with disabilities that
experience the social determinants of poor
health
Health Disparities
 In spite of startling evidence of health disparities
among people with disabilities and the inherent
costs to treat preventable conditions, current
federal law does not consider individuals with
disabilities a “medically underserved population.”
Health Disparities
• It also does not include disabilities under
requirements for cultural competence and
fails to recognize disability health
disparities under any federal program that
addresses health disparities.
Why is this Important?
 Why
is this important?
 Achieving optimal health is a goal for
everyone. Health disparities exist for
persons with disabilities, in part due to
insufficient information about and
available services for wellness promotion.
Why is this Important?
 Persons
with disabilities, as all persons
seeking health care and wellness services,
benefit from access to care providers
who have the knowledge and skills to
address the full range of their health
concerns, including their special needs.
Why is this Important?
 “Health”
has the same meaning for
persons with and without disabilities.
Disability itself is not an illness, and people
living with disabling conditions can be
healthy despite the disease or disorder
causing the impairment. Being healthy
includes having the knowledge and tools
to promote wellness and prevent illness
Why is this Important?
 We
know that people with disabilities as a
whole have a greater prevalence and
more complex mix of multiple chronic
conditions than people without disabilities
Why is this Important?
 It
is our right to have equal access to
good health, opportunities, housing,
employment, etc.
Overview
•
This presentation will cover;
 The Levels of Health Care Interventions
 The difference between Heath Disparity and
Health Equity
 The Prevalence of Disability, Poor Health, and
Incidence of Chronic Conditions
 Influence of Race and Ethnicity
 Opportunities
Levels of Intervention
 Three
Levels of Health Intervention
 Accessing/addressing the lack of culturally and
linguistically appropriate Health Services
 Addressing the Social Determinants of Health
 Addressing the Social Determinants of Equity
Levels of Intervention
 Addressing
the Lack of appropriate
Health Services
 Limited access to health care impacts
people's ability to reach their full
potential, negatively affecting their
quality of life.
Access to Health Care
 Barriers
•
•
•
to services include:
Lack of availability
High cost
Lack of insurance coverage
Access to Health Care
•




These barriers to accessing health services lead
to:
Unmet health needs
Delays in receiving appropriate care
Inability to get preventive services
Hospitalizations that could have been prevented
Social Determinants of Health
 Social Determinants of Health
 The
social determinants of health are the
circumstances in which people are born, grow up,
live, work, and age, as well as the systems put in
place to deal with illness. These circumstances are
in turn shaped by a wider set of forces:
economics, social policies, and politics.
Social Determinants of Health
 Also known as social and physical determinants of
health, they impact a wide range of health,
functioning and quality of life outcomes.
Social Determinants of Health

Social Determinants

Examples of social determinants include:
Availability of resources to meet daily needs, such as
educational and job opportunities, living wages, or
healthful foods
Social norms and attitudes, such as discrimination
Exposure to crime, violence, and social disorder, such
as the presence of trash
Social support and social interactions
Exposure to mass media and emerging technologies,
such as the Internet or cell phones
•
•
•
•
•
Social Determinants
 Social Determinants
•
•
•
•
•
Socioeconomic conditions, such as concentrated
poverty
Quality schools
Transportation options
Public safety
Residential segregation
Physical Determinants
•
•
•
•
•
•
•
Natural environment, such as plants, weather, or
climate change
Built environment, such as buildings or transportation
Worksites, schools, and recreational settings
Housing, homes, and neighborhoods
Exposure to toxic substances and other physical
hazards
Physical barriers, especially for people with disabilities
Aesthetic elements, such as good lighting, trees, or
benches
Social Determinants of Health
 Addressing the
 Involves
Social Determinants of Health
the medical care and public health
systems, but clearly extends beyond these
 Requires collaboration with multiple sectors
outside of health, including education, housing,
labor, justice, transportation, agriculture, and
environment
Social Determinants of Equity
 Axes of Inequity
include;
 Race
 Gender
 Ethnicity
 Disability status
 Labor roles
 Social Class
Social Determinants of Equity
 Differences
in access to goods, services
and opportunities
 Examples include;
 Housing
 Education
 Employment
 Income
 Medical Facilities
Social Determinants of Equity
 Examples;
 Living Environment
 Information/Resources
 Voice to be heard
 Inequity leads to self devaluation
 Unfair advantage to some
 Unfair disadvantage to others
Social Determinants of Equity
 Racism
 Racism
is the crux of inequity
– is speaking of a system of power,
a system of structuring opportunity and
assigning value based upon the social
interpretation of how we look
Social Determinants of Equity
 Racism
 Unfairly
disadvantages some individuals
and communities, while unfairly giving
advantages to other individuals and
communities
Social Determinants of Equity
 Two
Levels of Racism
 Institutionalized
Racism – provides
differences of access to goods and
services
 Internalized racism – acceptance by
those stigmatized of negative messages
about their own abilities
Social Determinants of Equity
Addressing Social Determinants of Equity
 Involves
monitoring for inequities in exposures
and opportunities, as well as for disparities in
outcomes
 Involves examination of structures, policies,
practices, norms, and values
 Requires intervention on societal structures and
attention to systems of power
Health Disparities/Health
Equity

•
•
Health Disparity
Health disparities adversely affect groups of
people who have systematically experienced
greater obstacles to health based on their
racial or ethnic group; religion; socioeconomic
status; gender; age; mental health; cognitive,
sensory, or physical disability; sexual orientation
or gender identity; geographic location; or
other characteristics historically linked to
discrimination or exclusion.”2
http://www.healthypeople.gov/hp2020/advisory/PhaseI/sec4.htm#_Toc211942917.
Accessed 4/26/13.
Health Disparities/Health
Equity

Health Equity
 Healthy People 2020 defines
health equity as the
“attainment of the highest level of health for all
people. Achieving health equity requires valuing
everyone equally with focused and ongoing
societal efforts to address avoidable inequalities,
historical and contemporary injustices, and the
elimination of health and health care disparities.”2
•
http://www.healthypeople.gov/hp2020/advisory/PhaseI/sec4.htm#_Toc21194
2917. Accessed 4/26/13.
Health Disparities/Health
Equity
 While we will address disparate health, our focus
should always be on obtaining health Equity
Health Equity and Inequity
Health equity is achieved when all people have the
opportunity to be as healthy as possible and no one
is limited in achieving good health because of their
social position or any other social determinant of
health.
Health inequity results when disparities or
differences are combined with conditions that are
unfair, unjust and avoidable.
Health Equity and Inequity
 As we move forward we must;


Address the social determinants of health,
including poverty, in order to achieve large and
sustained improvements in health outcomes
•Address the social determinants of equity,
including racism, in order to achieve social justice
and eliminate health disparities
Health Equity and Inequity
 Until we solve
the problem of equity, there will
always be some form of disparity
 If we take care of the problem of the Social
Determinants of Equity, the other health
interventions (Social determinants of health and
equal access) will fall in place
Prevalence of Secondary
Conditions for PWD
 Individuals
with Disabilities are more likely to
experience early death, chronic conditions, and
preventable health conditions
• Individuals with disabilities experience higher
incidence of obesity, osteoporosis, diabetes, high
blood pressure, and oral disease.
Prevalence of Secondary
Conditions for PWD
• Research shows that individuals with disabilities
experience greater unmet health needs than the
non-disabled population and receive fewer routine
and preventative services such as blood pressure
checks, and cholesterol and cancer screenings.
Influence of Race and
Ethnicity

African-Americans have a higher rate of disability than
their prevalence in the general population would
suggest (15.8%).

They are significantly more likely to have hypertension
(43.8%), diabetes (13.9%), and obesity (39.9%) than
Caucasian adults with disabilities (28.0%, 7.6%, and
22.8%) than Caucasian adults with disabilities (28.0%,
7.6%, and 22.8% respectively)
Influence of Race and
Ethnicity
•
African Americans with disabilities have the
highest rate of unemployment
 African Americans with disabilities have the 2nd
highest prevalence of fair or poor health
In the multivariate analyses, African-Americans with
disabilities had twice the odds of having
hypertension and diabetes, and 1.5 times the odds of
having obesity, as Caucasians with disabilities did.
Influence of Race and
Ethnicity
 There
is an intersection between minority status
and ethnicity that African Americans/Hispanics
etc. have referred to “double jeopardy” that
increase the likelihood of inadequate healthcare
and cultural bias
 This status does not only effect African Americans
with Disabilities, but other persons of color as the
next few slides will project.
Double Jeopardy
Person with
Double
Minority
A Disability
Jeopardy
Status
Influence of Race and Ethnicity
Prevalence of Disability by Race – Adults 18 Years of Age and Older
2009 Prevalence
Influence of Race and Ethnicity
Table 1. Percentage employment status of the civilian non institutional population by disability
status and race/ethnicity, 2010 Annual averages Population > = 16 years, US Department of Labor
BLS, 2010
Racial/Ethnicity
% Employed
% unemployed
% not in the labor
force
Total, age>=16 years
58.5%
9.6%
36.3%
Disability
18.6%
14.8%
78.2%
White
19.3%
13.6%
77.6%
Black/African
American
Asian
13.8%
22.00%
82.3%
16.0%
12.0%
81.7%
Hispanic/Latino
19.0%
18.4%
76.7%
No Disability
63.5%
9.4%
29.9%
White
64.6%
8.5%
29.4%
Black
57.4%
15.8%
31.9%
Asian
62.5%
7.4%
32.5%
Hispanic/Latino
62.4%
12.3%
28.9%
Influence of Race and Ethnicity
Table 2: Disability Prevalence by Race/Ethnicity and Percentage with Fair or Poor
Health
Race/Ethnicity
% with a Disability % with a Disability
reporting Fair or
Poor Health
White
21.6
36.4
% without a
Disability
reporting Fair or
Poor Health
5.8
Black/African
American
Hispanic/Latino
22.6
47.6
13.4
17.5
54.1
23.2
Asian
10.5
31.5
8.5
Nat. Haw./Pac.
Island
Multi-Race
17.9
47.6
13.4
30.6
45.3
9.6
Total
21.1
40.0
9.2
Source: Centers for Disease Control and prevention, CDC Health Disparities and Inequalities ReportUnited States 2011; Rationale for regular reporting on health disparities and Inequalities-United
States, MMWR 2011 (Suppl):3-10.
Influence of Race and Ethnicity
Prevalence of Chronic Conditions
Adapted from: Jones, GC. (Dec-2005) Health disparities among African-Americans with disabilities:
Implications for evidence-Based Health Promotion. Philadelphia, PA. American Public Health Association
133rd Annual Meeting & Exposition.
Opportunities
 What
do?
can Centers for Independent Living
CIL Opportunities
 Pay
attention
 Educated yourself and consumers
concerning health care access,
secondary and chronic conditions
 Be a resource that empowers persons with
disabilities to be able to begin to manage
their health needs
CIL Opportunities
 Work
to become Culturally and
Linguistically Competency
 The Demographic of the US is changing.
 Funding is continually
decreasing/competition is increasing
 To remain viable CIL’s must be able to
“serve everyone who walks through the
door.”
Health Promotion and
Wellness
 Model
Living Well with a Disability Program
(U of Montana)
 Offers self help model promoting Health
and Wellness of Consumers. Highly
successful
 For Information contact Tracy Boehm,
MPH at 406-243-5741
[email protected]
Advocacy
 Centers
should advocate for:
• Access to quality care by health care providers
trained to treat individuals with disabilities,
including intellectual and other disabilities;
 Inclusion of individuals with disabilities in the
definitions of “medically underserved
populations” and “cultural competence;”
Advocacy
• A healthcare workforce trained to address the
needs of individuals with disabilities, including
physical, mental health, cognitive, sensory,
intellectual, and/or developmental disabilities;
Advocacy
• Inclusion of “disabilities” and “sign language
interpreters” in the Office of Minority Health’s
National Standards on Culturally and Linguistically
Appropriate Services (CLAS)
Advocacy
A delivery system prepared to provide appropriate,
accessible, and equivalent care for all individuals with
disabilities at all levels of service;

Advocacy/Opportunities
 Know
and Advocate for enforcement of
the following provisions written in the ACA
 Centers may be able to find a role
 I/R, Health Navigator, Disease State
management
 There are provisions written within the
ACA that can provide a foundation to
health care access
ACA/Opportunities
Section 4302 of the Affordable
Care Act includes
provisions to invest in the improvement of health
data collection and analysis strategy to capture
information such as race, ethnicity, and disability
status. Health reform must end these health
disparities by ensuring:
ACA/Opportunities
Health reform must end these health disparities by
ensuring:
• Access to affordable coverage for Americans with
all forms of disabilities without regard to preexisting conditions
 Inclusion of individuals with disabilities in the
definition of “medically underserved populations”
and “cultural competence”
ACA/Opportunities
• Inclusion of individuals with disabilities in all data
collection and reporting required for racial, ethnic,
gender, or geographic health disparities in a
manner than can facilitate identification and
reduction of disparities associated with all forms of
disabilities
ACA/Opportunities
• Equal treatment of the population of individuals
with disabilities in all policies, programs, and
research designed to decrease health disparities
 Inclusion of individuals with disabilities in
prevention and wellness programs
Questions
 Stanley
Holbrook [email protected]
 Dara Baldwin [email protected]
 Thank
you!!

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