1. Health Care Disparities
The World Health Organization (WHO)
defines health disparities as:
Differences in health outcomes that are
closely linked with social, economic, and
environmental disadvantage — are often
driven by the social conditions in which
individuals live, learn, work and play

2. It’s Been Said
“Of all the forms of inequality,
injustice in healthcare is the
most shocking and
inhumane “
Rev. Dr. Martin Luther King

3. Disparity
The lack of similarity or equality;
any quality difference;
the condition of being unequal

4. Definitions
Health: state of complete physical, mental and social
well-being.
Healthcare: the prevention, treatment and
management of illness and the preservation of mental
and physical well-being; services offered by the
medical and Allied health professions

5. Determinants of Health
1. Behavior
2. Physical environment
3. Social environment
4. Biology
5. Individual

6. Social Determinants
1. Education
2. Food
3. Decent and Safe Housing
4. Affordable Public Transportation
5. Health Insurance
6. Clean Water, Sanitation and Non-Polluted
Air

7. Leading Causes of Death
Heart Disease
Cancer
Accidents
Diabetes

8. Important Indicators of
Community Health
1. Health Disparities
2. Health Inequalities
3. Health Inequities

9. Overview of Racial and Ethnic
Health Disparities
Murray et al show a difference of 33 years between the longest living and shortest
living groups in the U.S.
This research found that:: Disparities in mortality across the eight Americas, each
consisting of millions or tens of millions of Americans, are enormous . The
observed disparities in life expectancy cannot be explained by race, income, or
basic health-care access and utilization alone. Because policies aimed at reducing
fundamental socioeconomic inequalities are currently practically absent in the
US, health disparities will have to be at least partly addressed through public
health strategies that reduce risk factors for chronic diseases and injuries.
Murray CJL, Kulkarni SC, Michaud C, Tomijima N, Bulzacchelli MT, et al. (2006) Eight Americas:
Investigating Mortality
Disparities across Races, Counties, and Race-Counties in the United States. PLoS Med 3(9): e260.
doi:10.1371/journal. pmed.0030260.

10. The 8 Americas

11. Economic Burden
$1.24 trillion
The combined costs of health inequalities
and premature death in the United States
between 2003 and 2006
Source:
Joint Center for Political and Economic Studies

12. Sources of Disparities in Care
• Patient level
– i.e. patient preferences
• Healthcare systems level
– i.e lack of interpretation and translation services
• Provider level
– i.e. bias clinical uncertainty

13. Measures of Health Care Disparities
• Prevention Quality
– Indicators, Ambulatory Care, Sensitive Conditions
• Vital Statistics
– Population, Births, Deaths
• Access
– Health Insurance, Geography
• Demographics
– Socioeconomic Status
• Clinical Indicators
– Co-morbidity (i.e obesity and diabetes)

15. Health Care
According to the Institute of Medicine:
Minorities are significantly less likely than the
rest of the population to have health insurance.
Lack of insurance negatively affects the quality
of health care received by minority populations.

16. By the Numbers
• 1/3 of the U.S population Minorities
• 50 million people Uninsured
• 50% are minorities ~25 million people
• 56 million people experience rates of preventable
hospitalizations
• 2 times that of non-Hispanic Whites
• 19 million patients served by Health Services and
Resources Administration (HRSA):
• 63% are Minorities
• 92% have Income Below Federal Poverty Level
SOURCE: www.hrsa.gov/ Health Services and Resources Administration

17. Factors That Influence Health Status
Race or Ethnicity
Religion
SES
Gender
Age
Mental Health
Disability
Sexual Orientation or
Gender Identity
Geographic Location

18. Major Considerations in
Healthcare Disparities
Care
Workforce
Population
Data Collection and Research

19. Disparities in the Health and Human
Services Infrastructure and Workforce
Hispanics ~ 16% of the U.S. population
< 6% of U.S. physicians
African Americans ~ 24% of the U.S. population
~ 6% of U.S. physicians
24 million adults with limited English proficiency
Minorities are more likely than non-Hispanic Whites to report
experiencing poorer quality patient-provider interactions

20. Noted Success
National Health Service Corps (NHSC) invests in the healthcare
workforce by placing health professionals in Health Professional
Shortage Areas to care for underserved populations.
7,000 NHSC clinicians provide healthcare services in
underserved areas in exchange for loan repayment or
scholarships:
~ 33% of these clinicians are minorities
50% serve in Community Health Centers (CHC)

21. US Census 2010

22. People QuickFacts Hempstead,NY
Population (2010) 53,891 19,378,102
Population (2012) 54,883 19,570,261
Population Hempstead, NY New York State
Population % change (4/1/2010-7/1/2012) 1.8% 1.0%
< 5 years old 8.5% 6.0%
< 18 years old 25.6% 22.3%
White 21.9% 65.7%
Black or African American 48.3% 15.9%
Two or More Races 5.0% 3.0%
Hispanic or Latino 44.2% 17.6%
Foreign 39.2% 21.8%
Language other than English at home (age +5) 46.9% 29.5%
High school graduate or higher (age +25) 69.5% 84.6%
Bachelor’s degree or higher (age +25) 16.5% 32.5%

23. Successful Note
CDC’s Racial and Ethnic Approaches to Community Health
(REACH)
• seek better health
• change local healthcare practices
• implement evidence-based public health programs
Communities Putting Prevention to Work (CPPW)
• support statewide
• community-based policy
• nutrition, physical activity, and tobacco control

24. Race and Medical Care
Minorities receive fewer procedures and poor
quality medical care than Whites
Mechanisms:
• Institutional Discrimination
• Socioeconomic Status
• Segregation
• Internalized Racism
• Inability to Communicate

25. Community Ranking Pediatric Preventative
Care Sensitive Hospitalizations per 100,000
Pediatric Population (2013)

26. How It’s Going
Community with Highest Admission Rate: Hempstead
Preventable pediatric admission rate 22 times the rate
of the community with the lowest rate (Melville).

29. 411
• Black are 2-4 times more likely than Whites and Hispanics
to be hospitalized for a potentially preventable conditions
• Black men and women are more likely to die from heart
disease vs. all other racial ethnic groups
• Minority women have lower rates of breast cancer than
White women but are more likely to die from the disease
• Life expectancy differs by nearly 10 years between Black
men (70 years) and White women (80+ years)

30. Head Start Program
Minorities make up 79% of the population served by Head
Start administered by the Administration for Children and
Families (ACF)
Goals of the program:
• Promote the social and cognitive development of children
• Provide educational, health, nutritional, social and other
services to enrolled children and families
• Help parents make progress toward their educational,
literacy, and employment goals
• Engages parents in their child’s learning

31. Kathleen G. Sebelius, Secretary,
Health & Human Services
“It is time to refocus, reinforce, and
repeat the message that health
disparities exist and that health equity
benefits everyone.”

32. References
American community survey; Hofstra University University
Centers for Disease Control and Prevention
Disparities across Races, Counties, and Race-Counties in the United States. PLoS Med
3(9): e260. doi:10.1371/journal. pmed.0030260.
Healthy People 2020
Health Services and Resources Administration www.hrsa.gov/
Long Island index 2015
Murray CJL, Kulkarni SC, Michaud C, Tomijima N, Bulzacchelli MT, et al. (2006) Eight
Americas: Investigating Mortality
National centers for health statistics 2005
Rev. Dr. Martin Luther King
US Census 2010
US Census 2015
http://www.countyhealthrankings.org/app/new-york/2015/county/snapshots/059