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PubMed2006

Indigenous health and socioeconomic status in India.

BACKGROUND: Systematic evidence on the patterns of health deprivation among indigenous peoples remains scant in developing countries. We investigate the inequalities in mortality and substance use between indigenous and non-indigenous, and within indigenous, groups in India, with an aim to establishing the relative contribution of socioeconomic status in generating health inequalities. METHODS AND FINDINGS: Cross-sectional population-based data were obtained from the 1998-1999 Indian National Family Health Survey. Mortality, smoking, chewing tobacco use, and alcohol use were four separate binary outcomes in our analysis. Indigenous status in the context of India was operationalized through the Indian government category of scheduled tribes, or Adivasis, which refers to people living in tribal communities characterized by distinctive social, cultural, historical, and geographical circumstances.Indigenous groups experience excess mortality compared to non-indigenous groups, even after adjusting for economic standard of living (odds ratio 1.22; 95% confidence interval 1.13-1.30). They are also more likely to smoke and (especially) drink alcohol, but the prevalence of chewing tobacco is not substantially different between indigenous and non-indigenous groups. There are substantial health variations within indigenous groups, such that indigenous peoples in the bottom quintile of the indigenous-peoples-specific standard of living index have an odds ratio for mortality of 1.61 (95% confidence interval 1.33-1.95) compared to indigenous peoples in the top fifth of the wealth distribution. Smoking, drinking alcohol, and chewing tobacco also show graded associations with socioeconomic status within indigenous groups. CONCLUSIONS: Socioeconomic status differentials substantially account for the health inequalities between indigenous and non-indigenous groups in India. However, a strong socioeconomic gradient in health is also evident within indigenous populations, reiterating the overall importance of socioeconomic status for reducing population-level health disparities, regardless of indigeneity.

Alcohol Drinking↗
PubMed2000

Strategies for reducing racial and ethnic disparities in health.

This report is the fourth in a series of programs made possible by a grant to Grantmakers In Health (GIH) from The Commonwealth Fund to bring grantmakers together with experts in policy, practice, and research to exchange information and ideas about key health issues facing the nation. On May 18, 2000, GIH convened a select group of grantmakers along with officials from the U.S. Department of Health and Human Services and other experts in research and practice for an Issue Dialogue on racial and ethnic disparities in health. Intended to both share lessons learned and stimulate new ideas, the Issue Dialogue proved to be a rich, although difficult discussion about the conditions that give rise to health disparities. Among the ideas discussed were the interaction of race and socioeconomic status on health, environmental justice, and the complexities of working with different racial and ethnic groups. At the same time, the forum focused on what health funders can do to support the development of programs to improve the health of minorities. This Issue Brief brings together key points from the day's discussion with factual information on racial and ethnic disparities in health and grantmaker activities drawn from a background paper prepared for Dialogue participants.

Delivery of Health Care↗
PubMed2006

Mammography self-report and mammography claims: racial, ethnic, and socioeconomic discrepancies among elderly women.

BACKGROUND: National self-report surveys show minimal racial disparity in mammography, whereas analyses of administrative data show large disparity. METHODS: Using the 1998-2002 Medicare Current Beneficiary Surveys, which contain participants' self-report and claims data, we developed multivariable adjusted models examining factors associated with self-reported mammography and self-reported mammography verified by billing records. RESULTS: No racial/ethnic disparities were found in self-reported mammography. Verified mammography, however, revealed significant disparities for race, education, income, insurance, and health status. CONCLUSIONS: Race, education, income, insurance, and health status are associated with a lower likelihood of self-reported mammography verified by the existence of claims data. These data caution against exclusive reliance on self-report survey data to assess disparity in mammography.

Aged↗
PubMed2006

Disparities in the reporting and treatment of health conditions in children: an analysis of the Medical Expenditure Panel Survey.

OBJECTIVES: To determine whether racial and ethnic disparities in health care use differ for physical and behavioral health conditions. DATA SOURCES: Secondary analysis of the 1996-1997 Medical Expenditure Panel Survey. STUDY DESIGN: Retrospective cohort study of children aged 2-18 years old who were members of participating households. Children were categorized as Hispanic, black, or white. Differences in caregiver-reported behavioral and physical health conditions and services use were compared, and estimates were weighted to reflect the complex sampling scheme. PRINCIPAL FINDINGS: Of eligible children weighted to represent over 44 million in each year, 13-15 percent were Hispanic, 14 percent black, and 68-70 percent white. After adjusting for potential confounding, Hispanic and black children were less likely to report externalizing behavioral conditions than white children. Black but not Hispanic children were more likely than white children to report asthma. In addition, Hispanic and black children were less likely to report ambulatory visits, and black children were less likely to report receiving a prescription medication than white children. There were no differences in reported emergency room visits or hospitalizations. Interactions between race and various health conditions, health status, insurance, and income were not significant. CONCLUSIONS: In this nationally representative sample, we identified racial and ethnic disparities in the reporting of health conditions and the use of discretionary health services. Disparities differed between those with behavioral conditions and those with physical conditions. These disparities were not explained by traditional measures including the presence of health conditions, health status, insurance, and family income, and suggest that national surveys such as Medical Expenditure Panel Survey may benefit from the inclusion of additional explanatory measures.

Adolescent↗
PubMed2006

Research and educational approaches to reducing health disparities among American Indians and Alaska Natives.

Research and educational programs have the potential to improve health care. American Indians (AIs) suffer from considerable health disparities as compared with the general U.S. population, including significantly higher incidence and prevalence of preventable diseases like diabetes, alcoholism, and their complications. Underfunding of health programs, including the Indian Health Service, and lower socioeconomic status among AIs contribute to these disparities. Improvements in disease prevention and treatment potentially offered by research and health education programs could help to reduce health disparities. However, a history of nonparticipation in the research process and a history of dishonest research practices have raised barriers to conducting research in AI communities. Additional barriers are generated from a shortage of AI researchers and health care professionals. A research paradigm that includes the community as a full partner is necessary to promote research and education in AI communities and to translate health research into reductions in health disparities.

Alaska↗
PubMedDate not supplied

Health as a socially mediated process: theoretical and practice imperatives emerging from research on health inequalities.

Population-based studies on health disparities provide compelling evidence that inequities in health status over the life course accrue from social conditions. Our knowledge of how such conditions exert their effect on health, however, is limited. An examination of explanations for health disparities shows that a theoretical perspective that enables the exploration of the links between broader social processes (macro) and experience (micro) would offer valuable insights for practice. This article introduces a theoretical perspective informed by Bourdieu and Smith that has been used to undertake such an analysis and that opens up possibilities for new practice forums and foci.

Anthropology, Cultural↗
PubMed2003

Disparities in health and health care: focusing efforts to eliminate unequal burdens.

Disparities in health and health care have been around for more than two centuries. Evidence suggests that health disparities in ethnic and racial minorities continue to be problematic, with little progress made to eliminate them over time. Ethnic and racial disparities exist for multiple and complex reasons. However, new solutions are needed to resolve some of these old problems. Framing the debate and discussion around the distinctiveness related to disparities in health and health care is a necessary beginning in eliminating unequal burdens in health status. Focusing efforts to eliminate unequal burdens can strengthen existing solutions and policy formation related to this issue. This article defines disparities in health and health care, describes current health disparities impacting ethnic/racial groups, reviews historical factors associated with existing disparities in ethnic/racial groups, and concludes with challenges and solutions to alleviate these disparities.

Cultural Diversity↗
PubMed2002

Heterogeneity of health disparities among African American, Hispanic, and Asian American women: unrecognized influences of sexual orientation.

OBJECTIVES: This study compared health indicators among self-identified lesbians/bisexual women and heterosexual women residing in Los Angeles County. METHODS: Respondents were English-speaking Hispanic, African American, and Asian American women. Health status, behavioral risks, access barriers, and indicators of health care were assessed. RESULTS: Prevalence rates of chronic health conditions were similar among women in the 3 racial/ethnic groups. However, lesbians and bisexual women evidenced higher behavioral risks and lower rates of preventive care than heterosexual women. CONCLUSIONS: Among racial/ethnic minority women, minority sexual orientation is associated with increased health risks. The effects of sexual minority status need to be considered in addressing health disparities affecting this population.

Adolescent↗
PubMed2004

Health status of Cambodians and Vietnamese--selected communities, United States, 2001-2002.

National health data often are reported for Asians in the aggregate and do not monitor the health of specific Asian subpopulations (e.g., Cambodians and Vietnamese) in the United States. In addition, surveys conducted in English exclude Cambodians and Vietnamese with limited English proficiency. This report summarizes and compares health data from 1) a survey of one Cambodian and three Vietnamese communities conducted during 2001-2002 for the Racial and Ethnic Approaches to Community Health (REACH) 2010 project and 2) a survey of Asians in the aggregate and the general U.S. population conducted by the 2002 Behavioral Risk Factor Surveillance System (BRFSS). The questions were identical on both surveys. The results of this analysis indicated that Cambodians and Vietnamese had lower levels of education and household income and substantially different health-risk profiles than both the aggregate Asian population and the general U.S. population. Public health agencies should examine the health status of racial/ethnic subpopulations and prioritize interventions that address disparities.

Adult↗
PubMed1993

Physician utilization disparities between the uninsured and insured. Comparisons of the chronically ill, acutely ill, and well nonelderly populations.

BACKGROUND: This study examines the associations between lack of health insurance coverage and physician utilization for the chronically ill, acutely ill, and well nonelderly populations in the United States. METHODS: Cross-sectional data from the 1989 National Health Interview Survey, conducted by the National Center for Health Statistics, were analyzed for the nonelderly population using a correlational, two-group design (N = 102,055). Analytic models, using multiple logistic regression, were tested to predict the odds and likelihood of physician utilization for the uninsured and insured in the three subpopulations (ie, chronically ill, acutely ill, and well), controlling for health status, number of conditions, and geographic, sociodemographic, and economic factors. Disparities in utilization were then calculated between the uninsured and insured for each subpopulation. RESULTS: The nonelderly uninsured were consistently less likely than the insured to have received any health care within 12 months. Moreover, there were differential effects of being uninsured on utilization depending on whether an individual was chronically ill, acutely ill, or well. Whereas chronically ill and well uninsured persons were half as likely to have seen a physician as their insured counterparts (odds ratio, 0.50), acutely ill uninsured persons were almost two thirds as likely to receive physician care (odds ratio, 0.62). Thus, the disparity in physician utilization between the uninsured and insured was larger for the chronically ill and well than for the acutely ill; uninsured acutely ill were less likely to go without care. Of the three populations, those in the well population had average disparities with the largest magnitude (40%), compared with disparities of the chronically ill (20%) and acutely ill (10%). CONCLUSIONS: These disparities represent large inequities in utilization of care by the uninsured, particularly for the chronically ill and well. Whether these disparities result from lower access or individual choice cannot be determined from this study. When viewed in light of other studies examining the impact of utilization on health status, these results provide support for the development of comprehensive health insurance packages with universal coverage and better inclusion of chronic and preventive care models in benefit packages.

Acute Disease↗
PubMed1997

Health and gender differences between middle and senior managers in the Canadian Public Service.

Most studies of the relationship between socioeconomic status (SES) and health have concentrated on disparities between the richest and poorest men; few studies have examined such relationships for women due to difficulties in measuring SES for women. For the present study, data collected from Canadian Public Service middle and senior managers provided an opportunity to examine associations between SES and health within the upper end of the SES spectrum for both genders, since women managers can be assumed to have a relatively high SES. Demographic, health and lifestyle characteristics are compared for middle and senior managers for each gender separately to determine whether women experience the health benefits associated with higher SES that have been previously observed for men. The results support the hypothesis that achieving a higher SES through work is a more stressful process for women than for men and that women's upward mobility is restricted compared to that of men. Despite these findings, there is little evidence that women's health has been adversely affected. Compared to male managers, fewer female managers smoke or drink and fewer have high body mass index, high blood pressure or high cholesterol levels. Female managers are also more likely to report being in good health.

Administrative Personnel↗
PubMed2006

Children's health and social mobility.

Children from low-income families are more likely than other children to have serious health problems. And, as Anne Case and Christina Paxson show, childhood health problems can prevent poor children from achieving economic success as adults. Income-related disparities in childhood health are evident at birth or even before, and the disparities grow more pronounced as children grow older. Not only do poor children have more severe health problems than wealthier children, but they fare less well than wealthier children who have the same problems. They also receive less and lower-quality medical care for their problems. And poor families may be less well equipped to manage their children's health problems, which could worsen their effects. The available U.S. data sets do not allow researchers to track individuals' health and economic well-being from birth into adulthood, but three British data sets are producing growing evidence that health in childhood is a determinant of educational attainment, which in turn affects adults' employment opportunities and wages. Children in poor health are also more likely to have poor health as adults, and their health as adults adversely affects their economic status. Case and Paxson note that eliminating income-related disparities in health problems in childhood would do little to reduce earnings disparities between richer and poorer adults. However, they emphasize that, for children in poor health, improvement in physical condition in childhood would lead to substantial improvement in economic circumstances. The authors cite several areas, including expanded prenatal care, maternal smoking cessation programs, and nutrition programs, as deserving particular attention. They contend that increased access to health care is not sufficient to improve children's health. The next wave of policies should focus on improving the quality of health care and strengthening the ability of parents to manage their children's health problems.

Child↗
PubMed2000

Race/ethnicity and health insurance status: 1987 and 1996.

Health insurance confers important private and social benefits. Disparities in coverage among the population remain an important public policy issue. The authors focus on the health insurance status of white, black, and Hispanic Americans in both 1987 and 1996 and identify gaps in minority health care coverage relative to white Americans. They also investigate the access of workers in these groups to employment-based health insurance. Identified are factors underlying changes in the insurance status of workers during the past decade in terms of changes in population characteristics and structural shifts underlying the demand for and supply of health insurance. The authors find that while coverage has declined for workers in most racial/ethnic groups, the experience of Hispanic males appears to be unique in that changes in their characteristics as well as structural shifts account for their decline in employment-related coverage. Structural shifts dominated the changes in coverage rates for other groups.

Adult↗
PubMed2003

Understanding health behavior and perceptions.

Oral health and general health status depend on a dynamic interplay of many factors, including the individual's personal characteristics, behaviors, and perceptions. There are differences and disparities among different racial and ethnic groups in terms of oral health status, and in the physical, socioeconomic, cultural, and political environment. Furthermore, response to the environment may vary among individuals and populations. Access to care and patient-provider interactions are key issues to consider. This article presents a conceptual model of the variable influences on behaviors and perceptions that determine oral health status in minority and other populations.

Delivery of Health Care↗
PubMed2005

The use of film, literature, and music in becoming culturally competent in understanding african americans.

Increasing the cultural competence of child and adolescent psychiatrists through the use of film, literature, and music can improve their ability to understand what African Americans experience and the impact these experiences have on mental health. It also may help clinicians recognize their own underlying biases. This understanding, in turn, could improve their ability to address effectively in treatment the issues pertinent to the African-American community and help eliminate the well-documented disparities in the health care quality and health status of minorities.

Black or African American↗
PubMed2005

Changes in reporting of race/ethnicity, socioeconomic status, gender, and age over 10 years.

BACKGROUND: The recognition of health disparities as an important aspect of US health care has led to renewed interest in the reporting of race/ethnicity and socioeconomic status (SES) in original research reports. PURPOSE: To describe reporting of race/ethnicity and SES, in comparison with age and gender, and to report changes with time. METHODS: All original research articles that focused on children and asthma that were published in The Journal of the American Medical Association, The New England Journal of Medicine, Pediatrics, The Journal of Pediatrics, and Archives of Pediatrics and Adolescent Medicine were reviewed for 2 time periods, 1991-1993 and 2000-2002. Each report was assessed for coding of age, gender, race/ethnicity (number of groups and which groups), and SES. RESULTS: In 1991-1993, 27 reports met the inclusion criteria; in 2000-2002, 74 were reviewed. Overall, significantly more reports described age (90.1%) and gender (78.2%) than SES (41.6%) and race/ethnicity (54.5%). During the 2 study periods, there were significant increases in studies reporting race/ethnicity (from 29.6% to 63.5%) but not in studies reporting SES or gender. Coding of race/ethnicity, even in the later time period, was largely confined to white (78.7%) and black (89.4%). Fewer reports coded Latino (55.3%) or Asian (14.9%). Only 2 of the 31 articles that coded Latino subjects contained information on ethnic subgroups, whereas none of the 8 articles included Asian subgroups. CONCLUSIONS: Original research reports in a specific area (asthma) for which health disparities have been well documented still contain few data on race/ethnicity and SES, particularly in comparison with age and gender. There has been some improvement in the past decade in the reporting of race/ethnicity, but the reporting of Latino and Asian subgroups remains poor. If we are to understand health disparities, then more appropriate reporting of SES and race/ethnicity is necessary.

Adolescent↗