Environmental Justice and Health Disparities in Maryland and DC

Report
Maryland Department of Natural Resources 2013
Black History Month Program
AFRICAN AMERICANS
ENVIRONMENTAL JUSTICE AND HEALTH
DISPARITIES
Arlee Gist, B.A., Deputy Director
Office of Minority Health and Health Disparities
Maryland Department of Health and Mental Hygiene
February 21, 2013
What is a disparity?
“…Differences in the incidence, prevalence, mortality, and
burden of diseases and other adverse health conditions
that exist among specific population groups in the
United States” *
What is a health disparity?
“A higher burden of illness, injury, disability, or mortality
experienced by one population group in relation to a
reference group; and a healthcare disparity can be
described as differences in, for example, coverage,
access, or quality of care.” **
* The Henry J. Kaiser Family Foundation, Policy challenges and opportunities in closing the racial/ethnic
divide in health care. Race, ethnicity, and health care issue brief. 2005, The Henry J. Kaiser Family
Foundation: Washington, D.C.
** National Institutes of Health (US). NIH strategic research plan to reduce and ultimately eliminate health
disparities; 2000 October 6.
Historic Perspective
1895 – Booker T. Washington at Atlanta Exposition Meeting:
discussed deficiencies in Negro health care
1899 – W.E.B. Dubois “The Philadelphia Negro: A Social Study”: a
sociological study of Negroes including health
1903 – W.E.B. Dubois “Souls of Black Folk”: discussed declining
health of Negroes post slavery
1968 –“Kerner Commission Report”: speaks of gains in Black
American’s social welfare, however health inequalities remain
severe and troubling
1976 – National Medical Association: met in Washington, D.C. and
discussed access, morbidity and mortality disparities between
Blacks and Whites
3
Historic Perspective (Continued)
1980 – Black Congress on Health Law and Economics: met in Dallas,
Texas and discussed strategies for bridging health care gaps
between Blacks and Whites
1985 – Report of the HHS Secretary’s Task Force on Black and
Minority Health (Heckler-Malone): identified the continuing
existence of health disparities
1999 – IOM Report: “Unequal Burden of Cancer”, Alfred Haynes &
Brian Smedley, Editors: cancer as experienced by ethnic minorities
and medically underserved
2002 – IOM Report: Confronting Racial and Ethnic Disparities
in Health Care: Brian Smedley, Adrienne Stith, Alan Nelson,
Editors: race and ethnicity remain as significant predictors of
health care quality
4
National Attention on
Health Disparities
Maryland Attention on
Addressing
Health Disparities
Report of the Governor’s
Commission on Problems Affecting
the Negro Population, 1943
• Found health disparities in birth rates and death rates
for minority populations compared to the White
population;
• Found that there was a disparity in the number of
hospital beds available to minorities compared to
whites;
• Noted that environmental factors such as inadequate
diet, occupational hazards, and poor housing conditions
may lower their resistance to infection and increase the
likelihood of disease.
Healy, J.P., Report of the Governor's Commission on Problems Affecting the Negro Population. 1943, African-American
Department.
Now is the Time
An Action Agenda for Improving Black and
Minority Health in Maryland, 1987
• A Governor appointed 27 member Commission
was charged with conducting “a thorough
examination of the programs and laws relating
to the health status of Maryland’s minority
citizens”;
• Focused on cardiovascular disease, AIDS,
cancer, maternal and child health, homicide,
aging, substance abuse, mental health, medical
indigency, and minority health manpower.
Maryland Department of Health and Mental Hygiene, Now is the Time: An Action Agenda for Improving Black and
Minority Health in Maryland. The Final Report of the Maryland Governor's Commission on Black and Minority Health. 1987,
Baltimore, MD
Report of The Governor’s
Commission on Black Males, 1993
• Studied the nature and extent of problems in employment, health care,
criminal justice, and education and the effect these problems have on
African-American males in Maryland.
• Recommendations include:
• Approaches to such extensive problems of health care and insurance
must be comprehensive;
• Address the need for better coordination and outreach within existing
programs;
• Address the need for development of additional programs aimed at
African American males that include new ways of creating health
environment, lifestyle, and positive changes in health indicators.
The Maryland State Governor's Commission on Black Males, Report of the Governor's Commission on Black Males.
Maryland's African-American Males Health, Education, Employment and Economic Development, and Criminal
Justice. 1993: Annapolis, MD.
Minority Population in Maryland, 2010
Maryland Population, 2010 U.S. Census by Race and Ethnicity (45.3%) Minority
Race Alone
All Ethnicity
Non-Hispanic
Hispanic
White
3,359,284
58.2%
3,157,958
54.7%
201,326
3.5%
Non-White
2,414,268
41.8%
2,144,962
37.2%
269,306
4.7%
Black
1,700,298
29.4%
1,674,229
26,069
Asian
Asian
318,853
5.5%
316,694
2,159
Hawaiian/ Pac Isle
3,157
0.1%
2,412
745
American Indian
20,420
0.4%
13,815
6,605
Some Other Race
206,832
3.6%
11,972
194,860
Two or More Races
164,708
2.9%
125,840
38,868
5,773,552
100.0%
5,302,920
MD Total
91.8%
470,632
Source: 2010 Census Demographic Profiles, Department of Planning, Projections and Data
Analysis/State Data Center, May 2011
8.2%
10
Health Disparities in Maryland
• Compared to Whites, the Black or African American death rates for the
period of 2007-2009 were:
• 1.2 times higher for heart disease
• 1.2 times higher for cancer
• 1.3 times higher for stroke
• 1.8 times higher for bloodstream infections
• 2.0 times higher for kidney diseases
• 2.3 times higher for diabetes
• 7.7 times higher for homicide
• 10.9 times higher for HIV/AIDS
• The cost of the Black vs. White disparity in admission rate and severity
disparities was about $800 million in Maryland for 2011.
• Black men’s prostate cancer mortality rate was 2.0 times higher
compared to White men, while the Black prostate cancer incidence was
1.4 times higher.
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Social Determinants of Health Disparities
and Environmental Justice
Black to White Rate Ratio for Selected Chronic Disease Metrics,
Maryland SHIP data
5.00
Black to White rate ratio
4.40
4.00
3.50
2.91
3.00
2.00
1.29
1.19
1.09
1.00
0.70
0.00
Heart
Cancer
Diabetes
HTN ED
Disease Death Rate ED visit rate visit rate
Death Rate
Source: Maryland Asthma Surveillance Report, Asthma in
Maryland, 2011. and BRFSS 2006-2010
Asthma ED % adults at
visit rate
good
weight**
% adults
current
smoker
** higher
is better,
Blacks are
worse off
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Asthma Disparity in Maryland
Black vs. White Disparity Rate for Adults with Asthma, Maryland 2009
Black-White Disparity Ratio for Adults with Asthma,
Maryland 2009
Black vs. White Ratio
10
8
6
5.0
4
3.1
2.3
2
Access to
healthcare
has become
the major issue for
higher mortality
rate
among Blacks in
Maryland.
1.1
0
Prevalence
ED Visits
Hospitalization
Mortality
Maryland BRFSS, 2009; Maryland HSCRC, 2009; Maryland VSA, 2005-2009
Rates are age-adjusted to the 2000 U.S. standard population.
Source: Maryland Asthma Surveillance Report, Asthma in Maryland 2011
13
Progress in Disparity
Elimination in Maryland
 Between 2000 and 2009 the gaps between the Black
and White age-adjusted death rates (Black rate minus
White rate) were reduced as follows:
– For All-cause Mortality,
the gap was reduced by 39%
– For Cancer Mortality,
the gap was reduced by 63%
– For Heart Disease Mortality,
the gap was reduced by 6%
– For Stroke Mortality,
the gap was reduced by 43%
– For Diabetes Mortality,
the gap was reduced by 46%
– For HIV/AIDS Mortality,
the gap was reduced by 46%
Source: CDC Wonder Mortality Data 2000-2009
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Maryland Plan to Eliminate Minority Health Disparities
Plan of Action 2010-2014
The Action Plan’s main
objectives
include:
Objective 1: AWARENESS – Increase awareness of the significance
of health disparities, their impact on the state and local communities,
and the actions necessary to improve health outcomes for
Maryland’s racial and ethnic minority populations.
Objective 2: LEADERSHIP – Strengthen and broaden leadership
for addressing health disparities at all levels.
Objective 3: HEALTH AND HEALTH SYSTEM EXPERIENCE –
Improve health and health care outcomes for racial and ethnic
minorities and underserved populations and communities.
Objective 4: CULTURAL AND LINGUISTIC COMPETENCY –
Improve cultural and linguistic competency.
Objective 5: RESEARCH AND EVALUATION – Improve
coordination and use of research and evaluation outcomes.
15
The Maryland Health Improvement
and Disparities Reduction Act
The Maryland Health Improvement and Disparities Reduction Act (SB
234) was signed on April 10, 2012.
• The new law has six main provisions
1. Establish Health Enterprise Zones (HEZ) in small geographic areas
having very poor health statistics, health disparities and high poverty.
The HEZ is eligible for loan repayment assistance, tax credits, capital
equipment credits, electronic medical records assistance and
participation in the Patient Centered Medical Home program, and funding
for four years.
2. Establish and incorporate a standard set of measures regarding racial
and ethnic variations in the State Quality Outcomes reports generated
by the Maryland Health Care Commission.
3. Require each non-profit hospital in the State to include in their
Annual Community Benefits Reports, a description of the hospital's
efforts to track and reduce health disparities.
16
The Maryland Health Improvement
and Disparities Reduction Act (Continued)
4. Require institutions that offer programs necessary for the
licensing of health care professionals in the State to report on
their actions taken to reduce health disparities.
5. Two State commissions that work with hospital and health
insurer data, shall recommend standards for evaluating the
impact of the Maryland Patient Centered Medical Homes on
eliminating health disparities.
6. Form a Workgroup to develop standards and criteria for
cultural competency in medical and behavioral health
treatment settings
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Health Enterprise Zones (HEZs)
The purposes of establishing HEZs is to target State
resources to:
• Reduce health disparities among racial and ethnic groups and
geographic areas;
• Improve health care access and health outcomes in underserved
communities; and
• Reduce healthcare costs and hospital admissions/readmissions.
• The criteria of becoming an HEZ are:
• Each HEZ is a contiguous geographic area;
• Must have documented evidence of health disparities, economic
disadvantage and poor health outcomes; and
• Small enough to allow incentives to have a significant impact but
large enough to track data (population of at least 5,000).
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The Reduction Act’s Implications for
Environmental Justice and Health Equity
• HEZ alleviates environmental health disparities by concentrating
and targeting resources at contiguous geographic areas
(Zipcodes) where disadvantaged populations experiencing poor
health outcomes;
• The Reduction Act allows hospitals and other health care settings
to track health disparities data (e.g., asthma, lead poisoning,
cancer, birth defects, etc.,) broken down by race and ethnicity;
• Workforce and student cultural competency training among
various health care settings and higher education institutions.
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Online Resources
• Maryland Minority Health and Health Disparities
http://dhmh.maryland.gov/mhhd/SitePages/Home.aspx
• Health Disparities Workgroup Final Report and Recommendations. E, Albert Reece,
MD., PhD., MBA. Maryland Health Quality and Cost Council.
http://www.governor.maryland.gov/ltgovernor/documents/disparitiesreport120117.pdf
• Maryland Health Improvement and Disparities Reduction Act of 2012
http://mlis.state.md.us/2012rs/bills/sb/sb0234t.pdf
• Maryland State Health Improvement Process (SHIP)
http://dhmh.maryland.gov/ship/SitePages/Home.aspx
• Maryland Health Disparities Plan of Action 2010
http://dhmh.maryland.gov/mhhd/Documents/Maryland_Health_Disparities_Plan_of_Act
ion_6.10.10.pdf
• Maryland Health Disparities Data Chartbook 2012
http://dhmh.maryland.gov/mhhd/Documents/2012%20Maryland%20Health%20Disparities
%20Data%20Chartbook.pdf
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Contact Information
Office of Minority Health and
Health Disparities
Maryland Department of Health and Mental Hygiene
201 West Preston Street, Room 500
Baltimore, Maryland 21201
Website: www.dhmh.maryland.gov/mhhd
Facebook: www.facebook.com/MarylandMHHD
Phone: 410-767-7117
Fax: 410-333-5100
Email: [email protected]
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