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The update also summarizes recent journal articles and other research developments in the field and features a data slide from a relevant Kaiser Family Foundation publication.
DISPARITIES IN THE NEWS
1. Contra Costa Takes Unusual Approach to Reduce Health Disparities 2. Researchers at Pitt Minority Health Center Going to Maryland 3. Addressing Problems in Hmong Health Care 4. Project Examines Impact of Racial Inequity; American Healing Seeks Opportunity for Impoverished 5. Communities of Color Coalition Finds ‘Toxic’ Conditions for Multnomah County Minorities 6. Advance Notice; Heart Health has Improved Dramatically, but not Equally for All7. Ending Health Disparities Takes Interdisciplinary Approach 8. Organ Transplant Program ‘Mistrust’ Studied 9. U.S. Infant Deaths on the Decline 10. Hard to Breathe; Schools See Increase in Asthma Cases 11. Program Takes Up Fight Against AIDS Among Young Black Men 12. Report: Blacks Often Diagnosed at More Advanced Cancer Stages 13. African-Americans are Twice
as Likely as Whites to Develop Alzheimer’s Disease DISPARITIES IN RESEARCH 14. Health Status and Health
Services Access and Utilization Among Chinese, Filipino, Japanese,
Korean, South Asian, and Vietnamese Children in California 17. Social Context Explains Race Disparities in Obesity Among Women
Quick Facts About Asian Americans, Native Hawaiians and Other Pacific Islanders
DISPARITIES IN THE NEWS 1. Contra Costa
Takes Unusual Approach to Reduce Health Disparities During the first phase of the program, employees who make home visits to pregnant women and young mothers will help them apply for public benefits, repair their credit scores, open bank accounts, and address other financial concerns. In explaining the program, a county report states that “[i]mproving families’ financial status will increase their access to health care, improve their housing situations, offer opportunities to live in safer and healthier neighborhoods, increase food security, and enhance other protective social and environmental factors.” 2. Researchers at
Pitt Minority Health Center Going to Maryland Similar to the Center for Minority Health at Pittsburgh, the new Maryland Center for Health Equity will be a “base for community-level research and outreach to reduce health disparities” in underserved communities. Among the successful programs at Pittsburgh is The Black Family Project, which aims to reduce high rates of diabetes and hypertension among African-Americans, and an outreach program that provides health information to customers through barber shops and beauty salons. The five researchers headed to Maryland are Stephen Thomas, Sandra Crouse Quinn, James Butler, Craig Fryer, and Mary A. Garza. “The new team in Maryland will continue its partnerships and collaborations begun in Pittsburgh. Ongoing research in the Pittsburgh community and with partners at Pitt also will continue” (Daly, 5/15). 3.
Addressing Problems in Hmong Health Care The Hmong, who have a population of about 8,000 in Merced County, have a number of health problems, but their problems are often not well documented. “‘The statistics are horrible,’ said Dr. Peter Kunstadter, program director, Asian Health Program, University of California.” “There have been no comprehensive studies on diabetes in the Hmong at all, and we all know that diabetes is a huge problem in the Hmong.” In addition to diabetes, cancer and high blood pressure are other health conditions that, while not unique to the Hmong, are undertreated in their population. Speakers at the meeting also noted that access to health care is another problem the Hmong face. Dedicating the meeting to a Hmong man who died from complications related to diabetes and high blood pressure, Marilyn Mochel, the executive director of Healthy House Within A MATCH Coalition, a nonprofit organization in Merced that aims to improve access and equity for underrepresented populations, said “[w]e need to address the health care problems, because these are real people that are impacted” (Reiter, 5/14). 4. Project
Examines Impact of Racial Inequity; American Healing Seeks Opportunity
for Impoverished According to Dr. Gail Christopher, the Kellogg Foundation’s vice president of programs, the purpose of the America Healing is “to move our country toward racial equity, specifically on behalf of vulnerable children, a disproportionate number of whom are of color.” Statistics from the National Center for Children in Poverty show that about 60% of African-American, Latino, Native American, and children of immigrant parents are poor compared to about 30% of Asian-American and white children. $15 million in grants has been awarded to 119 groups thus far, with projects targeting issues such as disparities in education and health attainment (Ihejirika, 5/12). 5. Communities
of Color Coalition Finds ‘Toxic’ Conditions for Multnomah County
Minorities 6. Advance
Notice; Heart Health has Improved Dramatically, but not Equally for All Since 1950, the heart disease death rate dropped 65% for white men compared to just 50% for black men. In Mississippi, there has been no change in the heart disease death rate for black men in the past 30 years. Many researchers are studying why the heart disease death rate has not decreased as dramatically for African Americans as it has for whites, including Dr. Herman A. Taylor Jr. who is leading the Jackson Heart Study in Mississippi. Dr. Taylor believes that diet, exercise, obesity, and stress all play a role in heart disease among the African-American population in Jackson. Only a small percentage of the participants in his study get regular exercise, and the majority are overweight and eat either a “fast food diet” or “Southern diet.” Other experts also note culture and poverty as potential contributors to heart disease. “Taylor said he’s optimistic that by studying African-Americans in Jackson, he can learn how to improve the cardiovascular health of blacks — and everyone else. ‘What we learn through careful analysis of [this group] has relevance for everyone threatened by cardiovascular disease,’” he said (Weintraub, 5/3). . 7. Ending
Health Disparities Takes Interdisciplinary Approach Explaining that poor health literacy and failing to take medications correctly are situations that could be improved through an interdisciplinary approach to patient-center care, Rohack remarked that the recent meeting of the Commission – an association of 65 groups representing physicians, nurses, allied health professionals, insurers and industry – focused on this theme “as viewed through the lens of how new federal health care legislation would impact health care disparities.” Noting the importance of the role the Commission will play in guiding culturally competent care, Rohack said that “it is likely that health care disparities may worsen if not addressed proactively during the changes in store as the American health care system evolves.” “When patients do not understand their medical conditions or what to do to control them,” he concluded, “unnecessary health care costs will only increase. And that is a situation the AMA is committed to avoiding – both for our patients' health, and for our country's economic future” (Rohack, 5/3). 8. Organ
Transplant Program ‘Mistrust’ Studied Nationally, blacks are four times more likely than whites to have kidney failure, but are less than half as likely to receive transplants from living donors. In addition, Pittsburgh had the highest rate of kidney failure among blacks in 2008. To help identify the underlying reasons behind these disparities, researchers from the University of Pittsburg School of Medicine assessed the perceptions and experiences of 126 patients evaluated for kidney transplants at either the University of Pittsburgh Medical Center or the VA Pittsburgh Healthcare System. They found that black patients were more likely than white patients to report experiencing discrimination or perceiving racism in health care, feelings of medical mistrust, and holding objections to receiving a kidney from a living donor due to religious reasons. Patients who reported such discrimination, those who were not college educated, and those who earned less than $25,000 a year, waited longer for kidney transplant approval. As lead researcher, Larissa Myaskovsky explained, “It’s the person's perception that really influences their behavior… Perception is just as important as what is actually out there when it comes to decision-making.” While the researchers note that perceptions of discrimination might not directly account for why a patient may forgo kidney transplantation, the researchers suggest that transplant centers could identify patients who perceived discrimination in order help to educate them about their options. The researchers will be expanding their study to other sites across the nation (Conte, 5/2). 9. U.S.
Infant Deaths on the Decline According to the report, the rate of infant deaths decreased from 6.68 deaths per 1,000 births in 2005 to 6.68 death per 1,000 births, a 2.6% decline. While the rate in 2006 was about 13% less than the rate in 1995 (7.57 per 1,000 births), lead author of the study, T.J. Mathews, believes that the U.S. will probably still rank 28th out of 32 other industrialized countries in infant mortality. Disparities that affect rates of infant deaths also persist. For example, in 2006, the death rate for infants born to non-Hispanic black mothers (13.35 per 1,000 births) was nearly 3 times the rate of death for babies born to mothers of Central and South American descent (4.52 per 1,000). Additionally, 36.1% of infant deaths were “preterm-related,” but the rate of these deaths among black women was 3.4 times higher than the rate for Puerto Rican women, and 84% higher than that of white women. Mortality rates were also higher for infants who were born in multiple deliveries, whose mothers were born in the U.S., or with mothers who were unmarried at the time of birth. Jennifer L. Howse, president of the March of Dimes, remarked, “[o]bviously, disparities of income and access to health care are writ large in this area…but we are encouraged by the passage of the health reform legislation. As the implementation of health reform proceeds over the next couple of years, that's going to help improve these numbers” (Reinberg, 4/30). 10. Hard
to Breathe; Schools See Increase in Asthma Cases According to data from the National School Boards Association, about 10 percent of children in the U.S. have asthma, and it is the leading cause of school absenteeism. Dr. James M. Seltzer, an asthma specialist and allergist at Fallon Clinic at Worcester Medical Center, said that the prevalence of asthma has been increasing since 1980. While the reasons for the increased number of asthma cases is not entirely clear, “[t]he majority of new cases are disadvantaged people who live in inner cities, have poorer health care, and live in more challenging environments, including have a lot of irritants such as tobacco smoke, gas fumes, and smoke from wood-burning stoves or fireplaces in the home.” Though asthma can be treated, Dr. Seltzer explains that treatment can be difficult when people do not have the means to purchase items that may help control asthma, and/or lack access to health care, and along with it, the opportunity to learn how to control minimize irritants and control triggers. A report from the Massachusetts Department of Health found that roughly 65% of children in the state had asthma that was not well-controlled or very “poorly controlled. The National School Boards Association recently launched the “Asthma and Schools” website, and is working with the American Association of School Administrators and the Centers for Disease Control and Prevention to help schools support asthmatic children (Thompson, 4/29). 11. Program Takes Up Fight
Against AIDS Among Young Black Men Funded by the Centers for Disease Control and Prevention (CDC), the project, which focuses on issues beyond HIV prevention, like discrimination and homophobia within the black community, and uses social media platforms like Facebook and MySpace to reach people with safe-sex information, has reached over 300 black men in Dallas County so far. While there are no statistics on HIV rates among young gay or bisexual black men in Dallas County, “[i]t is widely believed that a relatively small group of young black gay men may be heavily infected with HIV.” Prior to this effort, there was no prevention program for black male youth in Dallas County where, in 2008, 52% of the new HIV cases in Dallas County were among blacks, though they accounted for only 21% of the county's population. “When the study ends next year, a survey will determine if more of these men practicing safe sex and being tested regularly for HIV.” Pending the results of the survey, the program may be duplicated in other cities (Jacobson, 4/29). 12.
Report: Blacks Often Diagnosed at More Advanced Cancer Stages “Cancer Facts and Figures for African-Americans 2009-10” shows that prostate (34%), lung (16%), and colon and rectum (10%) cancers were the most commonly diagnosed cancers for black men in 2009, while breast (25%), lung (12%), and colon and rectum (11%) cancers were the most commonly diagnosed among black women. The highest number of cancer deaths for both black men and women was due to lung cancer (31% and 23%, respectively), followed by prostate cancer in men (12%), and breast cancer in women (19%). According to Dr. Todd Scarbrough, a radiation oncologist at the Owensboro Medical Health System’s Mitchell Memorial Cancer Center, “The most popular, and probably most likely, theory about why that is is because of decreased access to care, whether that be due to socio-economic status, upbringing or your cultural feelings about going to the doctor.” He also noted that genetic differences may play a role. “Our biggest payoff in taking care of cancer, in curing cancer, is early screening,” Scarbrough said. “Getting access to good, quality medical care, and having that uninterrupted year after year after year, helps so that the small problems don't become big problems, and big problems don't become cancer” (Suwanski, 4/25). 13.
African-Americans are Twice as Likely as Whites to Develop Alzheimer’s
Disease While the cause of Alzheimer’s has not yet been determined, nor is it completely understood why African-Americans have a higher risk of developing the disease, risk factors for the Alzheimer’s include high blood pressure, stroke, diabetes, and heart disease, conditions for which the rates are much higher among African-American and other low-income communities than for whites. Latinos are similarly 1.5 times more likely to get Alzheimer’s but are also less likely to be diagnosed. Experts also offer that some racial and ethnic minorities may be reluctant to get tested for Alzheimer’s, despite the benefits of early diagnosis. Dr. Ladson, Hinton, director of the UC Davis Alzheimer’s Disease Center Education Core, explains, “[t]here's a real need to increase awareness and work with health care providers on how they can do a better job with their African-American patients… There also is a real need to work with the community to try to prevent Alzheimer's” (Kleffman, 4/20). DISPARITIES IN RESEARCH 14. Health
Status and Health Services Access and Utilization Among Chinese,
Filipino, Japanese, Korean, South Asian, and Vietnamese Children in
California Analyzing data on 648 Chinese, 523 Filipino, 235 Japanese, 308 Korean, 314 South Asian, 264 Vietnamese, and 8,468 non-Hispanic White children under the age of 12 from the 2003 and 2005 California Health Interview Survey, the authors found that, compared to non-Hispanic White children, Korean children had significantly greater odds of lacking health insurance (odds ratio [OR]: 3.47); Filipino children were 1.8 times more likely to have no doctor visit in the past year (OR: 1.81); and Chinese and Vietnamese children were less likely to delay obtaining prescribed medications (OR: 0.60, Chinese; 0.16, Vietnamese). Vietnamese children in California were also less likely to report never visiting a dentist than non-Hispanic White children (OR: 0.32). The authors conclude that the differences in access and utilization they observed among Asian subgroups “suggest that health care outreach to Asian ethnic groups should be customized according to their specific needs,” while also championing similar research in states with large Asian populations. (Yu, SM, Huang, ZJ, and GK Singh, “Health Status and Health Services Access and Utilization Among Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese Children in California,” American Journal of Public Health 100, no. 5 (May 2010): 823-830) 15. Paying
for Performance in Primary Care: Potential Impact on Practices and
Disparities Using a payment calculation algorithm adapted from a current Medicare demonstration program, the authors simulated a pay-for-performance program to practices in Massachusetts serving high or low proportions of patients from vulnerable communities in order to identify physician practices providing primary care. They found that practices serving higher shares of these patients were estimated to receive more than $7,000 less per year compared to other practices ($2,600 per year for a practice of 4 physicians with “high economic vulnerability” vs. $9,700 per year to a practice with “low economic vulnerability”). In no instance did the authors find that practices serving the most vulnerable patient populations would be paid more compared to other practices. The authors noted that their findings were “consistent with physicians’ reports of greater difficulty delivering high-quality care in practices serving large minority population, and with the initial distribution of performance-based payments in the U.K. National Health Service.” They also highlighted the potential importance of increasing the resources available to care for vulnerable populations while also retaining incentives to improve quality of care, especially when performance-based programs are in their infancy. (Friedberg, MW, et al., “Paying for Performance in Primary Care: Potential Impact on Practices and Disparities,” Health Affairs 29, no. 5 (2010): 926-932) 16. Perinatal Outcomes for Asian, Native Hawaiian,
and Other Pacific Islander Mothers of Single and Multiple
Race/Ethnicity: California and Hawaii, 2003-2005 The study authors analyzed two birth outcomes — low birthweight (LBW) and preterm birth (PTB) — using birth certificate data from the National Center for Health Statistics’ linked birth and infant data sets in California and Hawaii between 2003 and 2005. Among their findings were that, after adjusting for socioeconomic factors, Chinese-Filipino and Chinese-Native Hawaiian mothers had higher proportions of both LBW and PTB compared to Chinese-only mothers, and Filipino-White, Filipino-Native Hawaiian-White, and Chinese-Filipino-Native Hawaiian-White mothers had lower adjusted odds of LBW and PTB compared to Filipino-only mothers. In addition, “Filipino was the only API subgroup for which some multiple-race/ethnicity combinations conferred reduced odds of LBW or PTW, both before and after adjustment,” and only for Filipino women did biracial combinations including Whites carry greater odds of both PTB and LBW compared to single-race White women. The authors conclude that, given the heterogeneity of the API population as documented by their findings, efforts should be made to avoid combining API single- and multiple-race/ethnicity groups where possible, and strategies to improve perinatal outcomes for API mothers should consider this heterogeneity. (Schempf, AH, et al., “Perinatal Outcomes for Asian, Native Hawaiian, and Other Pacific Islander Mothers of Single and Multiple Race/Ethnicity: California and Hawaii, 2003-2005,” American Journal of Public Health 100, no. 5 (May 2010): 877-887) 17. Social
Context Explains Race Disparities in Obesity Among Women Comparing data from the Exploring Health Disparities in Integrated Communities-SWB (EHDIC-SWB) study – a multi-site study of race disparities within communities where blacks and whites of the same socioeconomic status live together – to national data from the National Health Interview Study (NHIS), the authors found that while black women had greater odds of being obese that white in NHIS (odds ratio [OR]: 1.99, 95% CI 1.71, 2.32), there were no racial disparities in obesity in the EHDIC-SWB sample (OR: 1.25, 95% CI 0.90, 1.75). As race disparities were only eliminated in the EHDIC-SWB sample because there was a higher prevalence of obesity among white women, the authors note the importance developing strategies that change the environment to lower obesity prevalence among low-income, urban women of all racial groups. (Bleich, SN, et al., “Social Context Explains Race Disparities in Obesity among Women,” Journal of Epidemiology and Community Health, 64, no. 5 (May 2010): 465-469)
May is Asian/Pacific American Heritage Month, originating from a joint congressional resolution in 1978 that named the first ten days in May as Asian and Pacific Heritage Week that was expanded in 1992 to be a month-long observance. There are over 13 million Asian Americans, and nearly one-half million Native Hawaiians and Other Pacific Islanders in the United States, and these were the populations with the largest growth in 2007-2008. For more information about Asian, Native Hawaiians and Other Pacific Islanders, please visit the Kaiser Family Foundation’s statehealthfacts.org and the Census Bureau’s Facts for Features, Asian/Pacific American Heritage Month. For more information about Asian, Native Hawaiians and Other Pacific Islanders, please visit the Kaiser Family Foundation’s statehealthfacts.org and the Census Bureau’s Facts for Features, Asian/Pacific American Heritage Month. |
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This free, monthly update synthesizes news coverage from hundreds of print and broadcast news sources related to health and health care issues affecting underserved and racial and ethnic communities. 
