Minority Health and Health Equity Archive
Permanent URI for this collectionhttp://hdl.handle.net/1903/21769
Welcome to the Minority Health and Health Equity Archive (MHHEA), an electronic archive for digital resource materials in the fields of minority health and health disparities research and policy. It is offered as a no-charge resource to the public, academic scholars and health science researchers interested in the elimination of racial and ethnic health disparities.
Browse
12 results
Search Results
Item Understanding Observed and Unobserved Health Care Access and Utilization Disparities Among U.S. Latino Adults(2009) Vargas Bustamante, A.; Fang, H.; Rizzo, J. A.; Ortega, A. N.Abstract available at publisher's website.Item Colonoscopist and Primary Care Physician Supply and Disparities in Colorectal Cancer Screening(2011) Benarroch-Gampel, Jaime; Sheffield, Kristin M.; Lin, Yu-Li; Kuo, Yong-Fang; Goodwin, James S.; Riall, Taylor S.Abstract available at publisher's web site.Item Segregation and Disparities in Health Services Use(2009) Gaskin, D. J.; Price, A.; Brandon, D. T.; LaVeist, T. A.Abstract available at publisher's web site.Item Emergency medical practice: advancing cultural competence and reducing health care disparities.(2009) Padela, Aasim I; Punekar, Imran R AIn an increasingly diverse patient population, language differences, socioeconomic circumstances, religious values, and cultural practices may present barriers to the delivery of quality care. These obstacles contribute to the health care disparities observed in all areas of medical care. Increasing cultural competence has been cited as part of the solution to reduce disparities. The emergency department (ED) is an environment where cultural sensitivity is particularly needed, as it is often a primary source of health care for the underserved and ethnic and racial minorities and a place where high patient volume and acuity place the provider under demanding time pressures, yet the emergency medicine (EM) literature on health care disparities and cultural competence is limited. The authors present three clinical scenarios highlighting challenges in providing equitable emergency care to minority populations. Using these cases as illustrations, three processes are proposed that may improve the quality of care delivered to minority populations: 1) increase cultural awareness and reduce provider biases, enabling providers to interact more effectively with different patient populations; 2) accommodate patient preferences and needs in medical settings through practice adjustments and cultural modifications; and 3) increase provider diversity to raise levels of tolerance, awareness, and understanding for other cultures and create more racially and/or ethnically concordant patient-physician relationships.Item The role of patient navigators in eliminating health disparities(2011) Natale-Pereira, Ana; Enard, Kimberly R.; Nevarez, Lucinda; Jones, Lovell A.Despite many important efforts to increase equity in the US health care system, not all Americans have equal access to health care—or similar health outcomes. With the goal of lowering costs and increasing accessibility to health care, the nation's new health care reform legislation includes certain provisions that expand health insurance coverage to uninsured and underinsured populations, promote medical homes, and support coordination of care. These provisions may help narrow existing health care disparities. Many of the most vulnerable patients, however, may continue to have difficulty accessing and navigating the complex US health care delivery system. This article explores the unique role that patient navigation can play in improving health outcomes for racial and ethnic minorities, as well as other underserved populations, in the context of a changing healthcare environment. Patient navigators can not only facilitate improved health care access and quality for underserved populations through advocacy and care coordination, but they can also address deep-rooted issues related to distrust in providers and the health system that often lead to avoidance of health problems and non-compliance with treatment recommendations. By addressing many of the disparities associated with language and cultural differences and barriers, patient navigators can foster trust and empowerment within the communities they serve. Specific patient navigator activities are discussed, and metrics to evaluate program efforts are presented. Cancer 2011;117(15 suppl):3541–50. © 2011 American Cancer Society.Item Racial and Ethnic Disparities in the Health and Health Care of Children(2010) Flores, G.OBJECTIVE: This technical report reviews and synthesizes the published literature on racial/ethnic disparities in children's health and health care. METHODS: A systematic review of the literature was conducted for articles published between 1950 and March 2007. Inclusion criteria were peer-reviewed, original research articles in English on racial/ethnic disparities in the health and health care of US children. Search terms used included "child," "disparities," and the Index Medicus terms for each racial/ethnic minority group. RESULTS: Of 781 articles initially reviewed, 111 met inclusion criteria and constituted the final database. Review of the literature revealed that racial/ethnic disparities in children's health and health care are quite extensive, pervasive, and persistent. Disparities were noted across the spectrum of health and health care, including in mortality rates, access to care and use of services, prevention and population health, health status, adolescent health, chronic diseases, special health care needs, quality of care, and organ transplantation. Mortality-rate disparities were noted for children in all 4 major US racial/ethnic minority groups, including substantially greater risks than white children of all-cause mortality; death from drowning, from acute lymphoblastic leukemia, and after congenital heart defect surgery; and an earlier median age at death for those with Down syndrome and congenital heart defects. Certain methodologic flaws were commonly observed among excluded studies, including failure to evaluate children separately from adults (22%), combining all nonwhite children into 1 group (9%), and failure to provide a white comparison group (8%). Among studies in the final database, 22% did not perform multivariable or stratified analyses to ensure that disparities persisted after adjustment for potential confounders. CONCLUSIONS: Racial/ethnic disparities in children's health and health care are extensive, pervasive, and persistent, and occur across the spectrum of health and health care. Methodologic flaws were identified in how such disparities are sometimes documented and analyzed. Optimal health and health care for all children will require recognition of disparities as pervasive problems, methodologically sound disparities studies, and rigorous evaluation of disparities interventions.Item Ethnic Disparities in Blood Pressure Management in Patients With Hypertension After the Introduction of Pay for Performance(2008) Millett, Christopher; Gray, Jeremy; Bottle, Alex; Majeed, AzeemPURPOSE Little is known about the impact of pay-for-performance incentives on health care disparities. We examined ethnic disparities in the management of hypertension among patients with and without cardiovascular comorbidities after the implementation of a major pay-for-performance incentive scheme in UK primary care. METHODS We undertook a population-based, cross-sectional survey of medication prescriptions and blood pressure control among patients with hypertension using electronic medical records from 16 family practices in southwest London. RESULTS Black patients with hypertension were signifi cantly less likely to achieve an established treatment target for blood pressure control than white or South Asian patients (adjusted odds ratio, 0.86; 95% confi dence interval, 0.74-0.99). The prevalence of cardiovascular comorbidities was higher among South Asian patients with hypertension than among their white or black counterparts (41.3% vs 28.5% vs 28.8%). The presence of 2 or more cardiovascular comorbidities was associated with signifi cantly improved blood pressure control among white patients but not among black or South Asian patients (mean systolic blood pressure, −9.4 mm Hg, −0.6 mm Hg, and −1.8 mm Hg, respectively). South Asian patients with poorly controlled hypertension were prescribed fewer antihypertensive medications than their black or white peers (adjusted odds ratio, 0.66; 95% confi dence interval, 0.46-0.96). CONCLUSIONS Ethnic disparities in the management of hypertension have persisted in the United Kingdom despite major investment in quality improvement initiatives, including pay for performance. These disparities are particularly marked among patients with multiple cardiovascular conditions.Item Health Care Disparities and Cervical Cancer(2004) Bradley, Cathy J.; Given, Charles W.; Roberts, CaraleeObjectives. We compared cervical cancer incidence, stage at diagnosis, and survival in Medicaid-insured and non–Medicaid-insured populations. Methods. We stratified the sample by age and used ordered logistic regression to predict stage at diagnosis and used Cox proportional hazards regression to predict survival. Results. Medicaid insured nearly one quarter of women diagnosed with cervical cancer. The likelihood of late-stage disease was greatest for women who enrolled in Medicaid after diagnosis. Women younger than 65 years who enrolled in Medicaid after diagnosis were more likely to die from cervical cancer than were women who were not insured by Medicaid (hazard ratio=2.40, 95% confidence interval=1.49, 3.86). Conclusions. Our study underscores the importance of cervical cancer screening programs targeted at low-income women.Item Addressing Health Care Disparities and Increasing Workforce Diversity: The Next Step for the Dental, Medical, and Public Health Professions(2006) Mitchell, Dennis A.; Lassiter, Shana L.The racial/ethnic composition of our nation is projected to change drastically in the coming decades. It is therefore important that the health professions improve their efforts to provide culturally competent care to all patients. We reviewed literature concerning health care disparities and workforce diversity issues—particularly within the oral health field— and provide a synthesis of recommendations to address these issues. This review is highly relevant to both the medical and public health professions, because they are facing similar disparity and workforce issues. In addition, the recent establishment of relationships between oral health and certain systemic health conditions will elevate oral health promotion and disease prevention as important points of intervention in the quest to improve our nation’s public health.Item Cultural Competence in Health Care(2004) Moxley, Andrea; Mahendra, Nidhi; Vega-Barachowitz, CarmenConsequently, speech-language pathologists and audiologists working in the health care setting must be prepared to provided services that are respectful of and responsive to cultural and linguistic needs of a diverse patient population. For instance, health care disparities in racial and ethnic minorities in the United States can no longer be discounted or ignored. The Institute of Medicine (IOM) Report, Unequal Treatment, summarized a growing body of literature documenting racial or ethnic differences in health care outcomes for many different diagnoses including coronary artery disease, diabetes, cancer, and HIV. Health care providers have to overcome cultural and communication barriers that may negatively influence appropriate diagnosis and treatment, provide culturally competent health care, and create health care systems that provide equitable access to all clients/patients.