Podium Presentation Session B Health Services, Policy and Social Determinants of Health #XUDisparitiesCollabs
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Cheryl Franklin, DNS, RN OPENING REMARKS #XUDisparitiesCollabs
Francine A. Small SPEAKER #XUDisparitiesCollabs
Francine A. Small FranK Consulting
Historically, claims about biological differences based on race were used to justify racial hierarchies Classification systems were developed using unfounded claims about population groups. 18 th century = Systemae Naturae and Blumenbach’s beautiful skulls
Issues about use: lack of definition and reason for choice of populations. There is agreement among researchers about the use of these terms on the condition there is accountability regarding definition. In 2002, recommendations were developed to provide researchers a framework to utilize race and ethnicity in a more accurate manner.
Papers were included: •If Race/Ethnicity used as an independent variable. Pub med search carried out with Papers excluded if: described limits •Race/Ethnicity in title but abstract not available. 356 Papers returned •Publication was: Letter, and abstracts Comment, Review, Meta reviewed -analysis, Practice guideline. •Race was only described as a 235 PDF’s “covariate” or “controlled downloaded, reviewed and included in the for” analysis •“Race” was an acronym or referred to athletics
Out of 235 publications race or ethnicity was defined only 4% of the time. Over 80% of the publications associated a medical outcome with race or ethnicity. The most commonly used racial or ethnic categories were “Black” ,“Hispanic”, ”White”, Caucasian and African American.
Hispanic, Non Caucasian, Black, Malay, African American, Native American, White, Alaskan, Caucasian , Pacific Islander, European, Alaskan Native, East Asian, Non Black, South Asian, American Indian, Asian, Alaska Native, Other, Bi multicultural, Asian Mixed, American, Non Hispanic, Non Hispanic, Black, Latino, Non White, Mexican Americans, Non-Hispanic European American, White, Japanese, Korean, Roma, Non Asian, Arab, Chinese, North African, Chinese American, African Caribbean, Thai , Coloured Indian,
Even today Spirometry device guidelines use racial/ethnic based adjustments to measure lung function/dysfunction. Historically: “Lesser development of lung tissue..” reflects the fact that “ the negro.....was a savage perhaps a cannibal” 1903 Journal of the American Medical Association – Dr. Seale Harris – Tuberculosis in the Negro Currently: “ Poorly supported idea” 2005 Journal of the History of Medicine and Allied Sciences - Dr. Lundy Braun - Spirometry, measurement, and race in the nineteenth century
Solution Difference Assumed Hypoth Potential assumed Function etical Impact due to results disease of test If base function Ensure 85% 75% 10% baseline closer to 100% testing of under-estimate lung of function disease/disability for within person compari- If base function 100% 75% 25% sons. less than 100% over-estimate of disease/disability
The historical and current concepts of “race” and “ethnicity” have been impacted by social events, geographical location and personal experience. Biomedical research currently uses racial/ethic categories without definitions, yet still ascribes medical associations. The Spirometry device guidelines are a contemporary example of the potential consequences of medical racial/ethnic misclassification.
The inappropriate linkage of race/ethnic groups to cause and/or effect in biomedical research can influence guidelines, policy and ultimately care. Future investigations should determine to what degree population based research on poorly defined racial ethic groups influences care at the patient-> community HCP level.
Nancy J. Greer-Williams SPEAKER #XUDisparitiesCollabs
Rural Ethnic Populations of Arkansas SOCIAL DETERMINANTS OF HEALTH AND IMPACT ON HEALTH BEHAVIOR
Disclaimer & Overview Purpose Methodology Results Findings Author has no financial interests or gains in the contents of this Conclusion presentation Questions
Studying social factors as the root cause of health disparities can be effective… Purpose: Research Design: To explore health disparities in Multi-method research design Arkansas communities for utilized: explanation of poor health ◦ Health Assessment Survey outcomes of African-Americans, instrument, Hmongs, Hispanics, Marshallese ◦ Focus groups, stratified by race & and Whites: gender ◦ Social Ecological Model (SEM) Health Insurance exchange, utilization of regional centers, and prevention behaviors Timeline: Data collection started October 22, 2013 and concluded November 19, 2013.
Health Assessment Survey Survey instrument was comprised • Pine Bluff-African 21 English of 32 items, which were divided American versions into 7 major sections: • Fayetteville-Hmong 5 English 1. Demographics versions • Hope-Hispanic 20 Spanish 2. Health insurance versions • Texarkana-Whites 7 English 3. Prevention behaviors versions • Fayetteville-Marshallese 15 English 4. Cancer/chronic disease versions • Fayetteville-Hispanic 12 Spanish 5. Regional center versions • Texarkana-African 23 English 6. Social support Americans versions • Total completed surveys 103 7. Health information
14 Focus Groups Social ecological model was used to Participant makeup: frame focus group guide and • African American men & women participant responses: • Hispanic men & women • 1) The individual (traits and Hmong men & women • behaviors); Marshallese men & women • White men & women 2) The relational (relationships, social support); 3) The environmental (built environment); 4) The structural (laws, policies, and politics); and 5) The superstructural (social justice issues such as racism, poverty, or sexism)
Results: Statements &Themes 1: Good health is important for a Individual level Challenges healthy lifestyle (individual influence) Poverty Unequal Distribution of Resources 2: There are challenges (individual influence) Low Levels of Limited English 3: Lack of social capital (relational Education Proficiency influence) Limited Life Skills Legal Status 4: The unhealthy environment (environmental) The Affordable Culture and Beliefs 5: Policies and the legacy of mistrust Care Act (structural) Perceptions of Chronic Stress 6: Classism, Racism and Poverty Unequal Treatment (superstructural)
Levels of Influence Social capital –the strength of connections within and between groups; Environmental –the built composition and layout of a community; ◦ Access to these resources was limited due to participants social-economic status, lack of transportation, language skills, or their lack of understanding the value of these resources. Structural – laws and policies that impact on health (local, state, national) Superstructural --Beyond the policies and political milieu of the community are the social justice issues that shape these policies
Conclusions Perceptions of racism These variables greatly impacted on participants’ understanding and unequal treatment, usage of: poverty, Health insurance exchange culture, Participation in health prevention programs low levels of education and life skills Usage of regional programs for healthcare needs created a sub-culture of people that were oblivious to cares and values of society.
Participants Recommendations What works against the stressors Leading institution identified by all and coping with social 5 ethnicities as a resource was the determinants. church: Spirituality was stressed as most There’s a lot more people going to important church. The people that go to church, they’re more literate too, Most black men have to be because they can read the bible. motivated to do something. I Even they have the Hmong bible. mean, you have to have some kind A lot of people—they sing a lot. of motivation for it to work…I was They learn how to read the words like that once, where I didn't have by singing. I just think in terms of no motivation, and I got my the people going to church are motivation through going to forced to be literate, forced to church and spiritual wellness learn (HMS). (AMT)
Dr. Nancy Greer- Williams Questions Nancy.greerwilliams@gmail.com
Questions & Answers #XUDisparitiesCollabs
Closing Remarks #XUDisparitiesCollabs
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