Module3lecture.pdf

8/13/2018

1

Overview of Health

Disparities in the US

Health Disparities PH-44000

US Health Disparities Overview

• There are those sub-populations “at-risk”
• Socially disadvantaged, marginalized, or medically

underserved
• Most often, when we discuss health disparities, we talk about

racial/ethnic groups and/or those with low-socioeconomic
status

• However, there are also “others” in the US affected by health
disparities

• Children
• Older adults
• Women
• LGBTQ+
• Rural
• People with disabilities or those differently-abled
• People experiencing homeless
• People experiencing incarceration

Children

• Defined as those < the legal adult age of 18 in most of the fifty states • Key health disparities among children include: • High infant mortality rate • More likely to be exposed to environmental hazards, and to be affected by them • Developmental issues • Adverse childhood experiences [ACEs] • Trauma • US has highest rate of child poverty 8/13/2018 2 Older Adults • Generally considered those > 60 years of age in the US

• Key health disparities among older adults include:

• More likely to have multiple chronic and/or life-
threatening conditions

• Ageism

• Limited access to care with greater unmet health needs

• More likely to receive no care at all

• Less likely to receive high quality care

• Significantly neglected in research

Older Adults

• Key health disparities among older adults include:

• Lack of family or friends

• Isolated, elder abuse, often taken advantage of

• Poverty and low socioeconomic status

• Variable access to and use of Medicare/Medicaid

• Limited transportation and housing services

• Inability to perform activities of daily living
• Going to the grocery store

• Self-care and grooming

• More susceptible to injury

Women

• Defined as those 18 years of age or older whose sex
and gender are congruent with the social identification
of female

• Key health disparities among women include:
• Single motherhood
• Victimization, sexism, misogyny, gender discrimination

(FMLA)
• Limited access to reproductive and/or contraception

services
• Increased rate of diabetes, IBS, STIs and STDs
• Twice as likely to be depressed as men

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LGBTQ+

• LGBTQ+ is an acronym used to define those who self-
identify as being lesbian, gay, bisexual, trans, queer, or
questioning

• The acronym in conjunction with the (+) symbol is used to be
inclusive of all identities of a gender and/or sexual minority

• Key health disparities among the LGBTQ+ include:

• Higher rates of substance abuse and smoking

• Increased incidence of HIV among men who have sex with
men (MSM)

• Higher rates of diagnosed mental health disorders and
cardiovascular disease

• Heterosexism, stigmatism, homophobia, transphobia

LGBTQ+

• Key health disparities among the LGBTQ+ include:

• Lack of social support and familial ties

• Disenfranchised grief and chronic stress

• Limited access to quality heath care

• Can be legally denied health services or fired from
employment in states that do not protect sexual
orientation or gender identity

• Historically neglected in research

• Fear and isolation

Rural

• As a sub-population, it is defined by geographic area

• Location must be at least one county away from metropolitan
(urban) area

• Key health disparities among rural populations include:

• Premature mortality and increased burden of morbidity

• Poorer maternal/child health outcomes
• More likely to smoke

• Physical inactivity, less access to healthy foods

• Higher rates of obesity, diabetes, and mental health
diagnoses

• Increased incidence of exposure to environmental or
occupational health hazards

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Rural

• Key health disparities among rural populations include:

• Poor oral health

• Limited educational opportunities

• Lack of employment opportunity and vocational diversity

• Limited access to healthcare

• Built environment and transportation issues

• Perceived or real isolation

• Stigmatism

• Poverty

People with Disabilities or “Differently-abled”

• Defined as a group of individuals who live with an impairment
(physical, cognitive, psychological, or otherwise) significant
enough to be life-limiting or make a notable difference in their
daily lives

• Key health disparities for people differently-abled include:

• Lack of access to education and limited mobility

• Stigmatism and lack of appropriate accommodations

• Underrepresentation in social spheres and in research

• Limited funding for rehabilitation

• Limited access to resources
• Poverty and underemployment

• Lack of employment opportunity and vocational diversity

Homelessness

• Many definitions offered but basically a group of people
experiencing homelessness are those who:

• Lack stable housing or whose primary residence during
the night is in a supervised public or private facility that
provides temporary living accommodations

• People who may live on the streets, stay in shelters,
missions, single room occupancy facilities, abandoned
buildings, vehicles, or in any other unstable or non-
permanent situation

• Individuals who are unable to maintain their housing
situation and are forced to stay with a series of friends
and/or extended family members

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Homelessness

• Key health disparities for people experiencing
homelessness include:

• Undiagnosed or untreated mental health conditions

• Victimization, poverty, hunger

• Substance abuse, STDs, cardiovascular disease

• Chronic or serious health conditions

• Lack of social support and opportunity for employment

• Limited access to health services

• Basic human needs are often unmet

• Stigmatism

Homelessness*

• In 2016, over half a million of people who participated
in a national survey identified themselves as
experiencing homelessness in the US

• The survey did not include information on those
experiencing homelessness in the US who did not
participate in the survey

• Of those who participated in the survey:
• 27% were children under the age of 18

• 50% were over the age of 50

• 8% were veterans

• 15% were chronically homeless
• Homeless for >1 year or 4+ episodes of experiencing

homelessness in 1 year, some of whom were attending
college

*http://www.socialsolutions.com/blog/2016-homelessness-statistics/

Incarceration

• Defined as a group of individuals in the state of being imprisoned
or confined within various types of governmental, state, or federal
institutions

• The US has only 5% of the world’s population, but 25% of the
world’s imprisoned persons

• Key health disparities for people experiencing incarceration
include:

• Substance abuse, victimization, and violence
• Undertreated mental health conditions
• Undertreated chronic or serious health conditions
• Higher rates of STDs and Tuberculosis
• Segregation and isolation
• Focus on punitive rather than rehabilitative approach
• Felony disenfranchisement

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Incarceration

Incarceration*

• Key health disparities for people experiencing
incarceration include:

• White/Caucasian people underrepresented

• African American/Blacks overrepresented

• US population compared to incarcerated population based
on ethnic/racial groupings

• 0.9% of Native American/American Indians in the US
• 1% are incarcerated

• 16% of Latinos/LatinX in the US
• 9% are incarcerated

• 13% of African American/Blacks in the US

• 40% are incarcerated

• 64% of White/Caucasians in the US

• 39% are incarcerated

* Compiled from the 2010 census