Kaiser Health Disparities Report: A Weekly Look at Race, Ethnicity and Health
Monday, May 04, 2009 thru Friday, May 08, 2009
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Coverage, Access and Quality
Politics & Policy
Public Health
Youth & Health
Initiatives
Recent Releases in Health Disparities
Coverage, Access and Quality
Two Government Reports Show Little Progress in Improving Patient Safety; Reducing Racial, Ethnic Health Disparities
[May 07, 2009]
The U.S. has not made substantial improvement in narrowing health care disparities among racial and ethnic groups, nor has it improved quality of care, according to two Agency for Healthcare Research and Quality reports released on Wednesday by HHS, Politico reports (Allen, Politico, 5/6).
The health care disparities report found that some improvements have been made to narrow the gaps in quality among ethnic groups, but some of the most significant disparities remain. For example, black U.S. residents continue to be almost 10 times more likely than whites to get HIV/AIDS -- a rate that has changed little since 2005. Blacks also are twice as likely to have a leg amputated because of diabetes, while pregnant black women are twice as likely not to receive prenatal care during their first trimester, according to the study.
In the quality-of-care report, researchers found measurable improvement in fewer than half of the 38 patient safety measures studied, such as accidental lacerations and catheter-associated infections. The study found that patient safety measures on average declined by nearly 1% annually in each of the last six years. According to AHRQ, one of every seven hospitalized Medicare beneficiaries has experienced at least one adverse event, a finding the agency called "disturbing." In addition, the study found significant variation in quality between states and among procedures. Carolyn Clancy, director of AHRQ, said that the study found a "collective lack of dramatic improvement" in quality of care, noting that the percentage of diabetics in 2005 who received each of three recommended annual treatments for the disease declined by five percentage points since 2003 to 40%.
According to the report, "Despite promising improvement in select areas, the health care system is not achieving the more substantial strides needed to close the gap or 'quality chasm' that persists." The report states, "Despite efforts to transform the U.S. health care system to focus on effective preventive and chronic illness care, it continues to perform better when delivering diagnostic, therapeutic or rehabilitative care in response to acute medical problems" (Sack, New York Times, 5/7). Sebelius Comments
Speaking to the American Federation of State, County and Municipal Employees Nurses Congress on Wednesday, HHS Secretary Kathleen Sebelius said the report found that "40% of recommended care is not received by patients." She added, "In addition, prevention measures are lacking. Only half of obese adults and children are given advice to exercise more and eat a healthy diet. Perhaps most troubling was the decline in patient safety measures indentified in the quality report, which have worsened each year for the past six years."
According to Sebelius, the economic stimulus package "includes $50 million to help prevent health care-associated infections, and I am pleased to announce that [HHS] is making these funds available today. Forty-million dollars will help states expand their infection prevention teams and educate and collaborate with hospitals to keep people safe. Ten-million dollars will support increased inspections of ambulatory surgical centers -- a frequent site of infections." She also said, "If we are to succeed and make health reform a reality, we need nurses at the forefront of the effort" (Politico, 5/6).
 The reports are available online.
Utah Law Requiring Verification of Legal Status for Certain Government-Funded Services Will Not Affect Health Services as Expected, Official Says
[May 08, 2009]
A new Utah law (SB 81) set to take effect July 1 that requires government agencies to verify residents' legal status before providing certain government-funded services will not affect health care services, Assistant Attorney General Doug Springmeyer said on Monday, the Salt Lake Tribune reports. Health care providers were concerned that the new law would curtail health services provided to immigrants; however, Springmeyer said that only two state health-related benefits -- child care and emergency medical service licenses -- would require proof of residency.
Springmeyer said Health Department officials erroneously informed agencies that accept primary care grants that they would have to verify their patients' legal status. The law only applies to state and local agencies, not their grantees, he said. According to Springmeyer, state and local government agencies can continue to provide services such as cancer screenings; prenatal advice; nutritional programs, including the federally funded Women, Infant and Children's program; medical and dental visits; and treatment for communicable diseases without requesting proof of citizenship.
"One of the messages public health wants to make sure is well-known in the community is they should feel free to come and seek that kind of care without any fear their citizenship status will have any bearing whatsoever," Springmeyer said. Judy Sobin -- executive director of the People's Health Clinic, which uses state funding to provide health care to uninsured adults working in the construction, restaurant and lodging industries in Summit and Wasatch counties, some of whom are likely undocumented -- said, "We're going to try to get the word out to our community they should feel very comfortable coming in for health care" (May, Salt Lake Tribune, 5/7).
Montgomery County, Md., Minority Health Advocacy Groups Protest Proposed Health Program Spending Cuts
[May 08, 2009]
A group of minority community leaders in Montgomery County, Md., on Thursday gathered at the County Council to protest a proposed 10% budget cut to minority health programs, the Washington Post reports. According to the group, the proposal by the council's Health and Human Services Committee would affect 16,000 people who receive services for diseases such as high blood pressure, diabetes and HIV/AIDS. In addition, the proposal would affect a program that provides breast pumps to low-income women (Marimow, Washington Post, 5/8).
Council member Roger Berliner (D) recommended the 10% cut to fund an expansion to the county's STI/HIV Clinic and the Tuberculosis and Immunization programs, which are funded through the county's Health and Human Services budget. County Executive Isiah Leggett (D) has already proposed cutting the program budgets by 2%. The group leaders called the additional 10% cut "shocking," according to the Montgomery County Gazette.
Diego Uriburu, a steering committee member of the Latino Health Initiative, said cutting the additional funding from initiatives that target black, Hispanic and Asian communities "shows a lack of understanding in what the (programs) actually do and what the communities go through." Uriburu and leaders from other groups submitted a 400-signature petition to the council opposing the additional cut. The council is scheduled to vote on the health and human services budget on Monday (Davis, Montgomery County Gazette, 5/7).
Black Women in Virginia More Likely Than Others To Experience Infant Mortality
[May 04, 2009]
Black women in Virginia are two-and-a-half times more likely than women of other races to experience infant mortality, according to the state Department of Health, the Newport News Daily Press reports. In 2007 in Hampton, there were four deaths per 1,000 live births among white infants, compared with 12.7 deaths per 1,000 live births among black infants. Nationwide, the infant mortality rate among blacks in 2000 was 14.1 deaths per 1,000 live births, according to the Office of Minority Health and Health Disparities. The national average is 6.9 deaths per 1,000 live births.
The leading cause of infant mortality in Hampton Roads is premature birth, followed by sudden undetermined infant death, according to the Daily Press.
Research by Jerome Strauss, dean of medicine at Virginia Commonwealth University, has found a connection between the environment and a genetic variation that causes the fetal membrane to rupture, leading to pre-term births in black women. "That's a significant risk increase. That's not going to explain all pre-term births that occur in African-Americans, but it's going to be a factor that's responsible," he said.
Thursa Crittenden of the Virginia Department of Health's Office of Minority Health and Public Health Policy, attributes part of the disparity to chronic stress that black women face, which predisposes them to poor health.
Pamela Hammond, dean of Hampton University's School of Nursing, noted that biology, access to health care and socioeconomic issues also contribute to health disparities. "There is no one factor that causes this health disparity. It is multifactorial," she said (Kelly, Newport News Daily Press, 5/3).
Arizona Agreement Aims to Extend PTSD Treatment to Navajo Nation
[May 04, 2009]
The Navajo Area Indian Health Service and the Northern Arizona Veterans Affairs Health Care System recently signed an agreement that aims to improve access to post-traumatic stress disorder treatment for war veterans, the Farmington Daily Times reports.
George Lawson -- one of the two social workers directed to provide services on the Navajo Nation reservation and a member of the Veterans Affairs' PTSD outreach team -- said, "Tapping the numbers is difficult. That's part of why we're here," adding, "We know the numbers are here, we just don't know how great they are."
The agreement allows Lawson and others to provide counseling and services in the remote locations on the reservation. The social workers also will help people sign up for Veterans Affairs benefits. The agreement also calls for the Indian Health Services to provide office space for the social workers.
"What we wanted to do was provide more outreach to Native Americans because they're in such a rural area," Ame Callahan, spokesperson for the Northern Arizona Veterans Affairs Health Care System, said. "The reservation is so far away from facility. We wanted to take the services to them instead of them having to travel a long way to us," she added.
The Northern Arizona Veterans Affairs Health Care System also plans to expand services to the Hopi Nation, with the goal of reaching out to and assisting veterans exhibiting PTSD symptoms, according to Callahan (Landry, Farmington Daily Times, 5/3).
Politics & Policy
Senate Unanimously Approves Roubideaux as IHS Director
[May 08, 2009]
The U.S. Senate on Wednesday unanimously approved Yvette Roubideaux, an assistant professor at the University of Arizona's College of Medicine, as director of Indian Health Service, the Arizona Daily Star reports. Roubideaux will be charged with overseeing HHS' efforts to improve health care for American Indians (Arizona Daily Star, 5/8).
Roubideaux, a member of the Rosebud Sioux tribe, has worked for IHS in the past as a medical officer and clinical director on the San Carlos Indian Reservation and in the Gila River Indian community. She also is the co-director of an effort that provides diabetes and cardiovascular disease prevention programming to 66 American Indian/Alaska Native communities (Kaiser Health Disparities Report, 3/24).
HHS Secretary Kathleen Sebelius, who also was confirmed on Wednesday, said,
"Dr. Roubideaux has spent her life working to improve health care for Native Americans. She has seen [IHS] through the eyes of a patient and a doctor, and I know she is the leader we need to strengthen IHS and ensure we keep our promise to provide quality health care to Native Americans" (Rapid City Journal, 5/7).
Yolo County, Calif., Delays Vote To Restrict County Health Services to Undocumented Immigrants
[May 07, 2009]
The Yolo County, Calif., Board of Supervisors on Tuesday delayed a vote on a proposal to eliminate county funding for health care services for undocumented immigrants as part of an effort to cut $1.5 million from the county's health budget, the Sacramento Bee reports. Instead the county officials will try to reach an agreement with local hospitals to help fund community clinics (Sangree, Sacramento Bee, 5/6).
California counties have been taking such action amid the economic recession to reduce their budgets. In February, Sacramento County voted to prohibit undocumented immigrants from receiving care at county clinics to save an estimated $2.4 million. Contra Costa County last month cut services for undocumented adults, seeking to save an estimated $6 million (Kaiser Health Disparities Report, 4/27).
Yolo County is facing a $24 million budget deficit for fiscal year 2009-2010.
At the meeting Tuesday, physicians and health officials said that cutting services for low-income residents would push them to seek care at hospital emergency departments. In addition, Yolo County officials also are concerned that undocumented immigrants from Sacramento County will seek care in Yolo County, the Bee reports.
The board will reconsider the proposal at its May 19 meeting. Board Chair Mike McGowan said supervisors would approve the cuts if the county does not finalize an agreement with hospitals about funding for clinics (Sacramento Bee, 5/6).
Public Health
Blacks, Hispanics More Concerned About Alzheimer's Diseases Than Whites, Survey Finds
[May 05, 2009]
Blacks and Hispanics are more concerned than whites about Alzheimer's disease but less knowledgeable about means to delay its onset, according to a new survey, United Press International reports. The survey was presented recently at the Congressional Black Caucus' Spring Health Braintrust and National Minority Quality Forum leadership summit in Washington, D.C.
The findings are based on a national telephone survey conducted by Dutko Research and Polling and commissioned by pharmaceutical subsidiary Eisai and CBC. The survey included responses from 601 black adults and 602 Hispanics from March 26 to April 7. The survey found that blacks expressed higher levels of concern about Alzheimer's disease than their white counterparts, but about half of black respondents knew that there were actions that people could take to delay the onset of Alzheimer's disease.
Sharon Richardson of Eisai, who presented the findings at the summit, said in a statement, "African-Americans and Hispanics are more likely to develop Alzheimer's. In addition, they have higher rates of diabetes, hypertension, high cholesterol and cardiovascular disease -- all of which increase the risk of Alzheimer's" (United Press International, 5/4).
Youth & Health
Study Looks at Mental Health Effects of Perceived Racism Among Young Children
[May 06, 2009]
Fifth-graders who believe they have experienced racial discrimination are much more likely than other children to have symptoms of depression, attention-deficit hyperactivity disorder and other mental health problems, according to a study published in the May issue of the American Journal of Public Health, USA Today reports.
Previous research has found that racial discrimination increases the odds of mental health problems in adolescents and adults, but this is the first study to examine the possible effects in younger children of varied races, Tumaini Coker -- study co-author, RAND researcher and University of California-Los Angeles pediatrician -- said. The study, led by Mark Schuster, a Harvard University pediatrician and pediatrics chief at Children's Hospital Boston, involved more than 5,000 children in Birmingham, Ala.; Houston; and Los Angeles.
Twenty percent of blacks, 15% of Hispanics, 16% of "other" races and 7% of whites reported experiencing prejudice. Hispanics reporting prejudice were more than three times as likely as other children to have symptoms of depression; blacks were more than twice as likely; and those of "other" races had almost quadruple the odds, according to the study. Participants experiencing prejudice also had higher rates of ADHD, oppositional defiant disorder and conduct disorder.
Schuster said that the findings do not prove that discrimination caused the mental health symptoms because researchers did not follow participants over time (Elias, USA Today, 5/6).
An abstract of the study is available online.
Initiatives
University of Miami Seeking Participants for National Study on Hispanic Health
[May 06, 2009]
The University of Miami is spearheading a nationwide study that will examine and compare the health and risk factors for chronic diseases among Hispanic subgroups, the Miami Herald reports.
Researchers are looking for 18,000 Cubans, Puerto Ricans, Mexicans and other Hispanics to participate in the study. Over the next three years, researchers will recruit participants from Hialeah, Fla.; Miami; the Bronx, N.Y.; Chicago; and San Diego. Participants will undergo a thorough health examination and be followed for two years through phone interviews concerning their health status.
Brendaly Rodriguez, recruitment and outreach manager for the UM study, said, "It's kind of like taking a picture of the health status of Latinos" (Pineiro, Miami Herald, 5/5).
Kaiser Permanente Gives UCLA Hispanic Physician Recruitment Program $2M
[May 06, 2009]
Kaiser Permanente is giving the University of California-Los Angeles a $2 million grant to fund a program that recruits foreign-trained doctors to practice in U.S. Hispanic neighborhoods, United Press International reports.
The International Medical Graduate Program will help Latin American medical school graduates pass U.S. licensing exams. The students will work in family medicine residency programs in California, according to Kaiser Permanente.
The goal is to increase the number of doctors in underserved, Spanish-speaking communities in California. According to Patrick Dowling, chair of the UCLA Department of Family Medicine, California will face a shortage of up to 17,000 physicians by 2015.
Dowling said about 2,500 physicians who were trained in Latin America are legal residents in California but cannot practice medicine in the U.S. The program is "committed to helping these skilled individuals navigate the road to licensure," Dowling said (United Press International, 5/5).
Please note: The Kaiser Family Foundation is not associated with Kaiser Permanente or Kaiser Industries.
Efforts Call for Racial Health Equity in Health Reform, Provide Immigrants With Public Health Assistance Information, Urge Use of EHRs Among Hispanics
[May 08, 2009]
The following highlights efforts that seek to reduce racial and ethnic health disparities.
- American Hospital Association: More than 20 national organizations on Monday in a letter to President Obama and Congress urged lawmakers to address racial health disparities as part of comprehensive health reform. The group said that health reform "should improve incentives, resources and data collection; increase the number of nurses, doctors, dentists, mental health practitioners and other caregivers in minority and underserved communities; and provide coverage and access to care for all, resources to address the factors that contribute to the disparities gap, and training to help health care providers deliver culturally competent care." The list of priorities is based on AHA Special Advisory Group on Improving Hospital Care for Minorities (AHA release 5/4).
- New York: The office of New York Public Advocate Betsy Gottbaum has published a new public benefits guide for immigrants, New York Daily News reports. The guide was developed by the New York Immigration Coalition and provides information about which services -- such as financial assistance, food stamps and health care programs -- immigrants might qualify for. The guide is available in English, Bengali, Chinese, Korean, Russian and Spanish (Wernick, New York Daily News, 5/7).
- Washington, D.C.: At the 2009 Latino Coalition's 2009 Economic Summit, coalition Chair Hector Barreto recognized MMR Information Systems electronic health records system mymedicalrecords.com for bringing EHRs to the Hispanic community. According to Barreto, MyMedicalRecords EHRs is the first bilingual EHR system to serve the Hispanic community and also help bring health care equality to the group. MMR provides EHRs and electronic safe deposit box storage solutions (MMR release, 5/6).
Recent Releases in Health Disparities
Neighborhood Factors Might Influence Whether Asian-Americans Smoke, Study Finds
[May 05, 2009]
"Association Between Neighborhood Context and Smoking Prevalence Among Asian-Americans," American Journal of Public Health: Namratha Kandula of the Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University and colleagues examined data from a 2003 health survey and the 2000 Census to examine the prevalence of smoking among Asian-Americans in California. Researchers looked at three neighborhood factors: ethnic enclaves, socioeconomics and perceived social cohesion. Twenty-two percent of 1,693 Asian men studied and 6% of 2,174 Asian women reported smoking. Women living in ethnic enclaves were less likely to smoke, while men who believed their neighborhood was more cohesive were less likely to smoke. Smoking prevention and cessation interventions targeting Asian-Americans might be more effective if they consider neighborhood characteristics, according to the study (Kandula et al., American Journal of Public Health, May 2009).
Issue Briefs Examine Racial, Ethnic Health Disparities Among Low-Birthweight Infants, Asthma Diagnoses
[May 07, 2009]
The Joint Center for Political and Economic Studies recently released two issue briefs that are a part of a series on health disparities among minority children. The issue briefs focus on Hispanic, black and white children younger than age 18 and make comparisons among the groups based on sociodemographic characteristics such as family type, educational attainment of householder, employment status of household, poverty status and health insurance coverage. The first brief examines the prevalence of low-birthweight infants and the second looks at lifetime asthma diagnoses (Joint Center for Political and Economic Studies, April 2009).
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