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!!