SLIDE 1
#XUDisparitiesCollabs
Podium Presentation Session B
Health Services, Policy and Social Determinants of Health
#XUDisparitiesCollabs
Podium Presentation Session B Health Services, Policy and Social - - PowerPoint PPT Presentation
Podium Presentation Session B Health Services, Policy and Social - - PowerPoint PPT Presentation
Podium Presentation Session B Health Services, Policy and Social Determinants of Health #XUDisparitiesCollabs Join our social media discussions #XUDisparitiesCollabs #XUDisparitiesCollabs Cheryl Franklin, DNS, RN OPENING REMARKS
SLIDE 2
SLIDE 3
#XUDisparitiesCollabs
OPENING REMARKS Cheryl Franklin, DNS, RN
SLIDE 4
#XUDisparitiesCollabs
SPEAKER
Francine A. Small
SLIDE 5
Francine A. Small FranK Consulting
SLIDE 6
Historically, claims about biological differences based on
race were used to justify racial hierarchies
Classification systems were developed using unfounded
claims about population groups.
18th century = Systemae Naturae and Blumenbach’s
beautiful skulls
SLIDE 7
Issues about use: lack of definition and reason for choice of
populations.
There is agreement among researchers about the use of
these terms on the condition there is accountability regarding definition.
In 2002, recommendations were developed to provide
researchers a framework to utilize race and ethnicity in a more accurate manner.
SLIDE 8
Papers were included:
- If Race/Ethnicity used as
an independent variable.
Papers excluded if:
- Race/Ethnicity in title but
abstract not available.
- Publication was: Letter,
Comment, Review, Meta
- analysis, Practice
guideline.
- Race was only
described as a “covariate” or “controlled for”
- “Race” was an acronym
- r referred to athletics
Pub med search carried out with described limits 356 Papers returned and abstracts reviewed 235 PDF’s downloaded, reviewed and included in the analysis
SLIDE 9
Out of 235 publications race or ethnicity was defined
- nly 4% of the time.
Over 80% of the publications associated a medical
- utcome with race or ethnicity.
The most commonly used racial or ethnic categories were “Black” ,“Hispanic”, ”White”, Caucasian and African American.
SLIDE 10
Hispanic,
Black,
African American,
White,
Caucasian,
European,
East Asian,
South Asian,
Asian,
Other,
Asian
American,
Non Hispanic,
Non White,
Non-Hispanic
White,
Korean,
Non Asian,
Chinese,
Chinese American,
Thai ,
Indian,
Non Caucasian,
Malay,
Native American,
Alaskan,
Pacific Islander,
Alaskan Native,
Non Black,
American Indian,
Alaska Native,
Bi multicultural,
Mixed,
Non Hispanic,
Black, Latino,
Mexican Americans,
European American,
Japanese,
Roma,
Arab,
North African,
African Caribbean,
Coloured
SLIDE 11
Even today Spirometry device guidelines use racial/ethnic
based adjustments to measure lung function/dysfunction.
Historically: “Lesser development of lung tissue..” reflects the
fact that “ the negro.....was a savage perhaps a cannibal” 1903
Journal of the American Medical Association – Dr. Seale Harris – Tuberculosis in the Negro
Currently: “ Poorly supported idea” 2005 Journal of the History of
Medicine and Allied Sciences - Dr. Lundy Braun - Spirometry, measurement, and race in the nineteenth century
SLIDE 12
SLIDE 13
Assumed Function Hypoth etical results
- f test
Difference assumed due to disease
Potential Impact
Solution
85% 75% 10%
If base function closer to 100% under-estimate
- f
disease/disability
Ensure baseline testing of lung function for within person compari- sons.
100% 75% 25%
If base function less than 100%
- ver-estimate of
disease/disability
SLIDE 14
- The historical and current concepts of “race” and
“ethnicity” have been impacted by social events, geographical location and personal experience.
- Biomedical research currently uses racial/ethic
categories without definitions, yet still ascribes medical associations.
- The Spirometry device guidelines are a contemporary
example of the potential consequences of medical racial/ethnic misclassification.
SLIDE 15
The inappropriate linkage of race/ethnic groups to cause
and/or effect in biomedical research can influence guidelines, policy and ultimately care.
Future investigations should determine to what degree
population based research on poorly defined racial ethic groups influences care at the patient-> community HCP level.
SLIDE 16
#XUDisparitiesCollabs
SPEAKER
Nancy J. Greer-Williams
SLIDE 17
Rural Ethnic Populations of Arkansas
SOCIAL DETERMINANTS OF HEALTH AND IMPACT ON HEALTH BEHAVIOR
SLIDE 18
Disclaimer & Overview
Author has no financial interests
- r gains in the contents of this
presentation Purpose Methodology Results Findings Conclusion Questions
SLIDE 19
Studying social factors as the root cause of health disparities can be effective…
Purpose: To explore health disparities in Arkansas communities for explanation of poor health
- utcomes of African-Americans,
Hmongs, Hispanics, Marshallese and Whites: Health Insurance exchange, utilization of regional centers, and prevention behaviors Research Design: Multi-method research design utilized:
- Health Assessment Survey
instrument,
- Focus groups, stratified by race &
gender
- Social Ecological Model (SEM)
Timeline: Data collection started October 22, 2013 and concluded November 19, 2013.
SLIDE 20
Health Assessment Survey
Survey instrument was comprised
- f 32 items, which were divided
into 7 major sections: 1. Demographics 2. Health insurance 3. Prevention behaviors 4. Cancer/chronic disease 5. Regional center 6. Social support 7. Health information
- Pine Bluff-African
American 21 English versions
- Fayetteville-Hmong
5 English versions
- Hope-Hispanic
20 Spanish versions
- Texarkana-Whites
7 English versions
- Fayetteville-Marshallese
15 English versions
- Fayetteville-Hispanic
12 Spanish versions
- Texarkana-African
Americans 23 English versions
- Total completed surveys
103
SLIDE 21
14 Focus Groups
Participant makeup:
- African American men & women
- Hispanic men & women
- Hmong men & women
- Marshallese men & women
- White men & women
Social ecological model was used to frame focus group guide and participant responses: 1) The individual (traits and behaviors); 2) The relational (relationships, social support); 3) The environmental (built environment); 4) The structural (laws, policies, and politics); and 5) The superstructural (social justice issues such as racism, poverty, or sexism)
SLIDE 22
Results: Statements &Themes
1: Good health is important for a healthy lifestyle (individual influence) 2: There are challenges (individual influence) 3: Lack of social capital (relational influence) 4: The unhealthy environment (environmental) 5: Policies and the legacy of mistrust (structural) 6: Classism, Racism and Poverty (superstructural)
Poverty Unequal Distribution of Resources Low Levels of Education Limited English Proficiency Limited Life Skills Legal Status The Affordable Care Act Culture and Beliefs Perceptions of Unequal Treatment Chronic Stress
Individual level Challenges
SLIDE 23
Levels of Influence
Social capital –the strength of connections within and between groups; Environmental –the built composition and layout of a community;
- Access to these resources was limited due to participants social-economic
status, lack of transportation, language skills, or their lack of understanding the value of these resources.
Structural – laws and policies that impact on health (local, state, national) Superstructural --Beyond the policies and political milieu of the community are the social justice issues that shape these policies
SLIDE 24
Conclusions
Perceptions of racism unequal treatment, poverty, culture, low levels of education and life skills created a sub-culture of people that were oblivious to cares and values
- f society.
These variables greatly impacted
- n participants’ understanding and
usage of: Health insurance exchange Participation in health prevention programs Usage of regional programs for healthcare needs
SLIDE 25
Participants Recommendations
What works against the stressors and coping with social determinants. Spirituality was stressed as most important Most black men have to be motivated to do something. I mean, you have to have some kind
- f motivation for it to work…I was
like that once, where I didn't have no motivation, and I got my motivation through going to church and spiritual wellness (AMT) Leading institution identified by all 5 ethnicities as a resource was the church: There’s a lot more people going to
- church. The people that go to
church, they’re more literate too, because they can read the bible. Even they have the Hmong bible. A lot of people—they sing a lot. They learn how to read the words by singing. I just think in terms of the people going to church are forced to be literate, forced to learn (HMS).
SLIDE 26
Questions
Nancy.greerwilliams@gmail.com
- Dr. Nancy
Greer- Williams
SLIDE 27
#XUDisparitiesCollabs
Questions & Answers
SLIDE 28
#XUDisparitiesCollabs