Finding the Way to Health Equity

By Ruth Ramsey, Publisher

As the bus pulls away, 28-year-old Debra* sighs with relief and walks the remaining blocks to her small apartment. Tired from working a long day, and worn down with worry about how to make her minimum wage paycheck stretch for the month, Debra, a single parent, puts the welfare of her children first.

Diagnosed with diabetes, she knows that she needs to watch her diet, but her money goes only so far. The fast food snack she had for lunch was probably a mistake, but it was what she could find in the area. And she knows she should get one of those blood monitoring things, but school shoes come first.

Debra figures if she doesn’t miss any work, she can get enough extra money to start taking night courses to become a nurse. That is if she and the kids stay well, because without health insurance, she can’t afford doctors’ bills.

Debra and many others in similar situations are part of an overwhelming trend: limited access to health care. There are many life situations that can turn a person into a health disparity statistic.

Defining Health Disparities

In order to solve a problem, first you need to define it. Over the years several definitions of “health disparities” have been documented. Simply stated, health disparities mean a significant difference in the illness, treatments and deaths from one group of people to another. Health disparities are found among racial and ethnic minorities, people in rural areas, women, children, the elderly, and people with disabilities. Although there are many causes for unequal health among different groups of people, social determinants play a large role.

Unmasking Health Disparities

We must navigate through a series of social determinants, the economic and social conditions under which people live, to understand how they affect health. Examples of social determinants are income, education, occupation, family structure, service availability, sanitation, exposure to hazards, social support, racial discrimination, and access to resources linked to health. There are at least five aspects from which social determinants are viewed:

Poverty and lack of insurance — Income is highly related to health care access and insurance coverage. Those with low income or no health care insurance may go without treatment. Or there may be an inadequate supply of health services or they do not receive the right care at the right time. Approximately 45.7 million people, or 15.3 percent of the U.S population, were uninsured in 2007, according to the Census Bureau. Many of these self-pay patients must navigate a system where the policy did not match the practice.

Lack of data and research — Access to an individual’s health history and health status is important to make sure that he or she receives appropriate, consistent and quality care. There is not a system in place that will enable an individual’s health records to be universally available for health care providers to manage one’s health.

There is also a need to collect data on race, ethnicity and primary language (with appropriate safeguards to protect privacy), so we can better understand how health related programs relate to racial and ethnic minority Americans.

Living environment — This can also refer to work places where the environment can be harmful to one’s health. One example is tobacco smoke where workers must breathe secondhand smoke on a daily basis. In an effort to improve workplace air quality, Kansas City passed an ordinance creating smoke free workplaces that went into effect in June. While it is still too early to see the health effects of such a change, other communities have seen better health because of similar smoking ordinances, according to Dr. Donald Potts, MD.

“Some cities such as Helena, Montana, saw improved health in as soon as six months,” said Dr. Potts. He referenced other places such as California where between 1989 and 2004 health costs dropped about $86 billion because of the California Tobacco Control Program.

Around the Kansas City metro area, 17 cities have a smoking ordinance. Six other cities and Wyandotte County are currently discussing a smoke free policy.

Lack of diversity and culturally competent health care workforce — while 29 percent of the U.S. population are minorities, only 3 percent of medical faculty and 17 percent of city and county health officers are minorities, as reported by Results.org, a nonprofit grassroots advocacy organization. Diversity is associated with improved access to care for racial and ethnic minority patients, greater patient choice and satisfaction, and better educational experiences for health professions students.

In the Kansas City area, KU School of Medicine and UMKC School of Medicine both work with community partners to encourage students of underserved and disadvantage d backgrounds to apply and succeed in health care careers.

According to Dr. Susan Wilson, Director of the Cultural Enhancement and Diversity Department at UMKC School of Medicine, of the students currently enrolled in the UMKC School of Medicine, about 15 percent are underserved minorities. Dr. Wilson said that this number has increased from 10 or 11 percent five years ago. UMKC defines underserved as African American, Latino and Native American, those groups traditionally not represented.

Across the state line, about 18 percent of the students enrolled in KU School of Medicine are from underrepresented groups, according to Dr. Patricia Thomas, Associate Dean of Cultural Enhancement and Diversity.

“Our students are able to have their education among a diverse student body which prepares them to take care of a diverse state and nation,” said Dr. Thomas.

Lack of Education – Nationwide, only about 70 percent of students earn their high school diplomas, according to the Alliance for Excellence in Education. Among students, 49.3 percent of American Indian, 53.4 percent of African American, 57.8 percent of Hispanic, 76.2 percent of Caucasian and 80.2 percent of Asian Americans students graduate with a regular diploma. Studies reveal that more education is associated with having higher income, which is a predictor of better health; less education is a predictor of health disparities.

To encourage students to stay in school and for those who are interested in health professions, both UMKC and KU have active “pipeline programs” designed to identify and help students prepare for health care professions. These programs, offered on Saturdays and during the summer, focus on math and science academics as well as other enrichment programs to help students prepare for college.

KU’s kindergarten through 12 programs touch 4,000 students per year. “We consider recruitment to mean not just the students who go into medical school, but those who pursue nursing and allied health careers because these are the students who will return to take care of those who are underserved” said Dr. Thomas.

Eliminating Health Disparities

To reach the goal of improved health for all Americans, we must eliminate unequal health care practices and monitor environmental and social conditions that lead to health disparities.

This is not a new mission; efforts to close the gap in health care are gaining speed on many fronts. Our Health Matters has featured many articles on ways to take control of one’s own health through good nutrition, daily exercise and being one’s own advocate on health issues. We have found no fewer than 12 government agencies that are mandated to work towards an effective and fair health care model.

Some of the federal and local organizations committed to eliminating health disparities include:

• Department of Health and Human Services (DHHS): The Department of Health and Human Services is the United States government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. DHHS oversees more than 300 programs that meet the needs of families, from infants to older Americans.

• Public Health Departments: Local health departments work to promote and preserve good health and protect and prevent illness of their citizens through programs such as immunizations and case management of chronic diseases.

• Kansas City Quality Improvement Consortium (KCQIC): A local program designed to help communities by bringing together consumers, health care providers and policy makers to develop best practices for quality care.

• Mother and Child Health Coalition: The Coalition serves as a catalyst for bringing together resources to promote plans to better the lives of women, children and families. It is the only area organization that focuses on both maternal and child health and recently added a fathering program.

• National and Local Offices of Minority Health: Their mission is to improve and protect the health of racial and ethnic minority populations through health policies and programs designed to eliminate health disparities.

Joining the ranks of serious health care advocates are consumers, community development and faith-based organizations that are uniting as one voice, demanding to be heard on such issues as access, quality care, best practices for management and treatment of chronic diseases and affordable health care cost.

It will take the effort of all to create a system where every citizen receives quality health care. Together we can make a difference.

To learn more about government efforts to eliminate health disparities visit The Agency for Healthcare Research and Quality at www.ahrq.gov.

To learn about bills introduced by the 110th Congress that focus on addressing racial and ethnic disparities in health and health care, visit: The Henry J. Kaiser Foundation website at: www.kff.org