Closing the Health Gap http://closingthehealthgap.org Thu, 26 May 2016 13:16:51 +0000 en-US hourly 1 http://wordpress.org/?v=3.6.1 How Cincinnati Shapes up on Life-expectancy; 4/29/16 http://closingthehealthgap.org/cincinnati-shapes-life-expectancy-42916/ http://closingthehealthgap.org/cincinnati-shapes-life-expectancy-42916/#comments Thu, 26 May 2016 13:16:51 +0000 Matt Vander Laan http://closingthehealthgap.org/?p=6263

 

How Cincinnati Shapes up on Life-expectancy

Chetty, R., Stepner, M., Abraham, S., Lin, S., Scuderi, B., Turner, N., … Cutler, D. (2016). The Association Between Income and Life Expectancy in the United States, 2001-2014.JAMA. doi:10.1001/jama.2016.4226

 

http://jama.jamanetwork.com/article.aspx?articleid=2513561

 

This study, led by Raj Chetty, aimed to better understand the relationship between income and life expectancy. Objectives were to measure the relationship between income and life expectancy; trends in life expectancy by income group; geographic variation in life expectancy levels and trends by income group; and factors associated with differences in life expectancy across areas.

 

Methods: Over 1.4 billion ...

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How Cincinnati Shapes up on Life-expectancy

Chetty, R., Stepner, M., Abraham, S., Lin, S., Scuderi, B., Turner, N., … Cutler, D. (2016). The Association Between Income and Life Expectancy in the United States, 2001-2014.JAMA. doi:10.1001/jama.2016.4226

 

http://jama.jamanetwork.com/article.aspx?articleid=2513561

 

This study, led by Raj Chetty, aimed to better understand the relationship between income and life expectancy. Objectives were to measure the relationship between income and life expectancy; trends in life expectancy by income group; geographic variation in life expectancy levels and trends by income group; and factors associated with differences in life expectancy across areas.

 

Methods: Over 1.4 billion individuals, age 40-76, were examined via records collected from deidentified tax and death records spanning from 1999 to 2014.

 

Results (Directly from article): First, higher income was associated with greater longevity throughout the income distribution. The gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6 years (95% CI, 14.4 to 14.8 years) for men and 10.1 years (95% CI, 9.9 to 10.3 years) for women.

 

Second, inequality in life expectancy increased over time. Between 2001 and 2014, life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5% of the income distribution, but by only 0.32 years for men and 0.04 years for women in the bottom 5% (P < .001 for the differences for both sexes)

 

Third, life expectancy for low-income individuals varied substantially across local areas. In the bottom income quartile, life expectancy differed by approximately 4.5 years between areas with the highest and lowest longevity. Changes in life expectancy between 2001 and 2014 ranged from gains of more than 4 years to losses of more than 2 years across areas.

 

Fourth, geographic differences in life expectancy for individuals in the lowest income quartile were significantly correlated with health behaviors such as smoking (r = −0.69, P < .001), but were not significantly correlated with access to medical care, physical environmental factors, income inequality, or labor market conditions. Life expectancy for low-income individuals was positively correlated with the local area fraction of immigrants (r = 0.72, P < .001), fraction of college graduates (r = 0.42, P < .001), and government expenditures (r = 0.57, P < .001).

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Is there a racial ‘care gap’ in medical treatment?; 4/30/16 http://closingthehealthgap.org/racial-care-gap-medical-treatment-43016/ http://closingthehealthgap.org/racial-care-gap-medical-treatment-43016/#comments Wed, 25 May 2016 13:17:53 +0000 Matt Vander Laan http://closingthehealthgap.org/?p=6265

 

Is there a racial ‘care gap’ in medical treatment? [Television series episode] (2016, April 5). In PBS (Producer), PBS NEWSHOUR.

 

African Americans are being undertreated for pain due to medical students’ false beliefs about biological differences based on race. This is both a medical and sociological problem as deeply embedded myths in U.S. society about racial difference, especially biological differences between races, affect how patients are being treated.

 

This is both a conscious and unconscious stereotype. Societal myths do greatly impact medical student perspectives but these racial distinctions ...

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Is there a racial ‘care gap’ in medical treatment? [Television series episode] (2016, April 5). In PBS (Producer), PBS NEWSHOUR.

 

African Americans are being undertreated for pain due to medical students’ false beliefs about biological differences based on race. This is both a medical and sociological problem as deeply embedded myths in U.S. society about racial difference, especially biological differences between races, affect how patients are being treated.

 

This is both a conscious and unconscious stereotype. Societal myths do greatly impact medical student perspectives but these racial distinctions are also being taught in medical school. After surveying 400/500 medical students it was found that these biases peaked around the 2nd year of medical school as students were preparing for their board exams and memorizing these kinds of associations.

 

Although there are certain medical conditions that are more likely to affect certain races, “race” itself is a socially constructed concept – it is not biological or genetic. These differences in medical conditions are often a result of social or ethnic effects.

 

These beliefs, aside from causing unequal medical treatment, are also in part what lead to health disparities. Racially disparate health outcomes are not based upon someone’s biological differences. Reversely, racism and other structural inequities cause health disparities.

 

Thus it is imperative that medical education shifts focus to how medical practice can address these inequalities and reverse some of these incorrect interventions.

 

http://www.pbs.org/newshour/bb/is-there-a-racial-care-gap-in-medical-treatment/

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Other factors include societal racism that leads to poorer housing, education, nutrition, and unsafe neighborhoods; 5/1/16 http://closingthehealthgap.org/factors-include-societal-racism-leads-poorer-housing-education-nutrition-unsafe-neighborhoods-5116/ http://closingthehealthgap.org/factors-include-societal-racism-leads-poorer-housing-education-nutrition-unsafe-neighborhoods-5116/#comments Tue, 24 May 2016 13:18:47 +0000 Matt Vander Laan http://closingthehealthgap.org/?p=6267

 

Title:   Other factors include societal racism that leads to poorer housing, education, nutrition, and unsafe neighborhoods.

Universal Health Care Action Network. http://uhcanohio.org/content/health-equity

 

Social Determinants of health: Education and Income are major players.  Disparities in non- completion of high school and poverty do exist.  Income disparity in non-completion of high school was greatest for those with family income below the national poverty level.  Percentage of those with disabilities who did not complete high school was about double that of adults without disabilities.  The proportion of those ...

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Title:   Other factors include societal racism that leads to poorer housing, education, nutrition, and unsafe neighborhoods.

Universal Health Care Action Network. http://uhcanohio.org/content/health-equity

 

Social Determinants of health: Education and Income are major players.  Disparities in non- completion of high school and poverty do exist.  Income disparity in non-completion of high school was greatest for those with family income below the national poverty level.  Percentage of those with disabilities who did not complete high school was about double that of adults without disabilities.  The proportion of those with disabilities who were under the poverty level was over twice that of those who do not have disabilities.

Environmental Hazards:

1)      Inadequate and Unhealthy housing:

a)      Proportion of unhealthy housing units has decreased.  Among those housing units classified as unhealthy, the magnitude of the disparities decreased across racial/ethnic, income, and educational level categories.  The disparity among race/ethnicity, socioeconomic status, disability status, and education are still very large.

Health-care access and preventative services:

1)      Health insurance coverage:

a)      Insurance is strongly correlated to a better health outcome.   Large disparities were observed for all demographic and socioeconomic groups.  Hispanics and non-Hispanic blacks were found to have substantially higher uninsured rates compared to Asian/Pacific Islanders and non-Hispanic whites.

2)      Flu vaccination coverage:

a)      lower vaccination rates were observed for non-Hispanic blacks and Hispanics, compared with non-Hispanic whites among all people who were older than 6 years old.

Fact Sheet-CDC Health Disparities and Inequalities Report.

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The Black Agenda Cincinnati 2016 http://closingthehealthgap.org/black-agenda-cincinnati-2016/ http://closingthehealthgap.org/black-agenda-cincinnati-2016/#comments Thu, 19 May 2016 18:32:19 +0000 Matt Vander Laan http://closingthehealthgap.org/?p=6276

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Do Right! Get Fit Workshops! http://closingthehealthgap.org/right-get-fit-workshops/ http://closingthehealthgap.org/right-get-fit-workshops/#comments Mon, 16 May 2016 14:42:41 +0000 Matt Vander Laan http://closingthehealthgap.org/?p=6293

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Getfit5.5.16

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The Health Gap has been named the 2016 Agency of the Year by the National Association of Social Workers (NASW). http://closingthehealthgap.org/health-gap-named-2016-agency-year-national-association-social-workers-nasw/ http://closingthehealthgap.org/health-gap-named-2016-agency-year-national-association-social-workers-nasw/#comments Mon, 09 May 2016 15:18:40 +0000 Matt Vander Laan http://closingthehealthgap.org/?p=6291

The Center for Closing the Health Gap – a Cincinnati non-profit dedicated to promoting awareness of health disparities through education, training, advocacy and outreach – has been named the 2016 Agency of the Year by the National Association of Social Workers (NASW).

 

The Health Gap was nominated by Marilyn Hoskins, a licensed social worker and a Region 6 Executive Board Member. The NASW is the largest and most recognized membership organization of professional social workers in the world. There are more than 130,000 members nationwide and ...

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smallbusinessaward5.9.16

The Center for Closing the Health Gap – a Cincinnati non-profit dedicated to promoting awareness of health disparities through education, training, advocacy and outreach – has been named the 2016 Agency of the Year by the National Association of Social Workers (NASW).

 

The Health Gap was nominated by Marilyn Hoskins, a licensed social worker and a Region 6 Executive Board Member. The NASW is the largest and most recognized membership organization of professional social workers in the world. There are more than 130,000 members nationwide and 4,700 in Ohio. NASW is the only organization dedicated to advocating for the entire profession of social work.

 

Other NASW 2016 award honorees include:

•             Public Citizen of the Year – Major Charmaine McGuffey

•             Public Official of the Year – Councilman Wendell Young

•             Emerging Leader of the Year – Angela P. King, LISW-S

•             MSW Student of the Year – Lauren Stoll

•             BSW Student of the Year – Jai’la Nored

•             Agency of the Year (large agency category) – Cincinnati Union Bethel

•             Outstanding Service to Social Work – Crystal E. Bossard, LSW/LICDC-S

•             Social Worker of the Year – Anzora Adkins

•             Lifetime Achievement – Jean Sepate, LISW-S

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Conversation to raise awareness about Men’s Mental Health http://closingthehealthgap.org/6279/ http://closingthehealthgap.org/6279/#comments Mon, 09 May 2016 13:33:59 +0000 Matt Vander Laan http://closingthehealthgap.org/?p=6279

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MHA Flyer May 21 2016 (2)

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Hospitals Eye Community Health Workers To Cultivate Patients’ Successes; 4/28/16 http://closingthehealthgap.org/hospitals-eye-community-health-workers-cultivate-patients-successes-42816/ http://closingthehealthgap.org/hospitals-eye-community-health-workers-cultivate-patients-successes-42816/#comments Thu, 28 Apr 2016 13:13:45 +0000 Matt Vander Laan http://closingthehealthgap.org/?p=6261

 

Luthra, S. L. (2016, April 11). Hospitals Eye Community Health Workers To Cultivate Patients’ Successes. Kaiser Health News.

Retrieved from http://khn.org/news/hospitals-eye-community-health-workers-to-cultivate-patients-successes/

 

The beginning of this article focuses on Donnie Missouri, age 58. Years ago he started his career with Johns Hopkins Hospital in the linens department and is now tasked with connecting hospital patients with resources like housing, transportation and other government benefits — factors that influence health but aren’t the doctor’s focus.

 

What’s Missouri’s secret? It’s a combination of building rapport, meeting patients at home and, most importantly, understanding the challenges ...

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Luthra, S. L. (2016, April 11). Hospitals Eye Community Health Workers To Cultivate Patients’ Successes. Kaiser Health News.

Retrieved from http://khn.org/news/hospitals-eye-community-health-workers-to-cultivate-patients-successes/

 

The beginning of this article focuses on Donnie Missouri, age 58. Years ago he started his career with Johns Hopkins Hospital in the linens department and is now tasked with connecting hospital patients with resources like housing, transportation and other government benefits — factors that influence health but aren’t the doctor’s focus.

 

What’s Missouri’s secret? It’s a combination of building rapport, meeting patients at home and, most importantly, understanding the challenges — medical and not — his neighbors face.

 

This kind of work done by community health workers is not new. But recently hospitals are starting to focus on these programs, utilizing community outreach workers to strengthen their relationships with patients and surrounding neighborhoods.

 

Yet challenges persist in financing community health worker programs even though research has shown that there is return on investment. However in once case, even though a hospital’s readmissions did drop by about half, the program didn’t save enough to offset the cost of running it. Still, the hospital is looking into expanding the model simply because they believe in it.

 

Some health systems have used grants (private or from CMS) to fund these programs. Once the grant funding ends, some hospitals choose to keep the programs running. In Maryland, the state has taken steps to reform hospital payments – rewarding health systems for keeping patients healthy enough that they don’t need hospital treatment. That adds financial incentives for Hopkins and other hospitals, encouraging them to use strategies such as outreach by community health workers. Federal policies also add appeal.  For example, the University of Maryland Medical Center started its community health worker project last year after Medicare penalized it for failing to meet national hospital admittance standards.

Now, state and federal regulators are struggling with how to set standards for community health workers’ training and certification as there’s currently no consensus. Some consider things like background checks necessary while others argue that people who have exposure with the corrections system are better-equipped to work with people coming through community programs with similar life experiences.

 

 

 

 

 

 

Wasserman, M. (2016, April 11). Geography, income play roles in life expectancy, new Stanford research shows. Stanford News. Retrieved from http://news.stanford.edu/news/2016/april/poverty-chetty-siepr-041116.html

 

Stanford economist Raj Chetty found that the link between income and life expectancy varies from one area to another within the United States. Men in the bottom 5 percent of the income distribution who live in New York, New York, can expect to live 5 years longer than men with comparable incomes in Gary, Indiana.

 

After researchers reviewed information from over 1 billion individuals spanning from 1999 to 2014, being richer was associated with living longer at every level of the income distribution. At 40, the richest men could expect to live to 87 while the bottom 1 percent had a life expectancy of just above 72 – equal to the average in a developing country like Sudan. Women at the top of the income distribution could expect to live close to 89 while the life expectancy of women at the bottom was 79 years – a 10-year gap. This inequality has only worsened since the turn of the century.

 

“We find very large differences across areas for the poor but very small differences across areas for the rich. Where you live matters much more if you are poor than if you are rich,” Chetty said.

 

Eight of the 10 states with the lowest levels of life expectancy for the poor formed a geographic belt from Michigan to Kansas, encompassing Ohio, Indiana, Kentucky, Tennessee, Arkansas and Oklahoma. Differences in health behaviors seem to play a more important role in Chetty’s findings than measures of health care coverage and access to medical care.

 

Local levels of income inequality and residential segregation by income did not seem to be associated with differences in health among the poor. Instead, measures of affluence, larger fractions of college graduates, higher share of immigrants and greater government expenditures were strongly linked with longer life expectancy for the poor.

 

It may be that these cities are often the first to enact public health policies that affect the health of the poor as well as the rich, such as smoking bans. It is also possible that when there are more people around you who are exercising and eating well, people are influenced by others’ good habits.

 

“If we think about a policy like indexing the retirement age to life expectancy, we need to think hard about which life expectancy we are talking about. If we just use average life expectancy in the U.S., we are going to essentially start hurting the poor, especially in certain areas – like Detroit – relative to the rich,” Chetty said.

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How Far Have We Come in Reducing Health Disparities? Progress Since 2000: Workshop Summary; 4/27/16 http://closingthehealthgap.org/far-come-reducing-health-disparities-progress-since-2000-workshop-summary-42716/ http://closingthehealthgap.org/far-come-reducing-health-disparities-progress-since-2000-workshop-summary-42716/#comments Wed, 27 Apr 2016 13:12:24 +0000 Matt Vander Laan http://closingthehealthgap.org/?p=6259

 

How Far Have We Come in Reducing Health Disparities? Progress Since 2000: Workshop Summary.

Institute of Medicine (US).

Washington (DC): National Academies Press (US); 2012.

 

Challenges to addressing health equity:

Effects of current economic downturn cannot be underestimated.  Perceptions that the US is in a post-racial state is false.

 

Study found that doing a paired test-one white and one Latino or African American- matched on personality, clothing, education and more- the tester of color received poorer treatment on average when applying for jobs or mortgages.

Another study found that, doing the ...

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How Far Have We Come in Reducing Health Disparities? Progress Since 2000: Workshop Summary.

Institute of Medicine (US).

Washington (DC): National Academies Press (US); 2012.

 

Challenges to addressing health equity:

Effects of current economic downturn cannot be underestimated.  Perceptions that the US is in a post-racial state is false.

 

Study found that doing a paired test-one white and one Latino or African American- matched on personality, clothing, education and more- the tester of color received poorer treatment on average when applying for jobs or mortgages.

Another study found that, doing the same paired test- one white with criminal background and one African American with no criminal background- were sent to find employment. The white member still had better chance of being hired than the African American member.

 

Governmental and Private sectors are addressing the disparities.

Government: Patient Protection and Affordable Care Act-improve access to car for lots of people of color as well as low income people.  Stimulus funding from the American Recovery and reinvestment Act of 2009. Started the Communities Putting Prevention to Work program.

 

Private Sectors showing leadership: Robert Wood John Foundation’s Commission to Build a Healthier America, Kellogg Foundation, California Endowment, Kaiser Family Foundation and MacArthur Research Network on Socioeconomic Status and Health.

 

Residential Segregation: Segregation persists at high levels still in the US.

Detroit Michigan shows a dissimilarity index of 85 meaning that 85 percent of white and African Americans would have to move to create racial integration.  Milwaukee, New York City, Chicago and Newark all have indexes of 80.

 

Link is drawn between people of color who live in highly concentrated poverty and residential segregation.  Living in such communities harmful to one’s health.  Health enhancing resources are more difficult to access in such communities and conditions that offer health risks are more prevalent.  (for example, food deserts).

Healthy people 2010:

No significant change in health disparities over the decade by race and ethnicity for 69% of the objectives (117 of the 169).

Of those 52 objectives (31%) that showed a significant change, 27 showed a decrease of 10% or more and 25 showed an increase of 10% or more.

 

Health insurance coverage between 1997-2008:

Total did not change. Income less than 100% federal poverty line increase 5% from 66% to 71%, for those between100% and 199% of the Federal poverty line remained the same at 69%.  And those with greater than 200% Federal poverty line decreased 1 percent 90% to 89%.  By age group; 10-14 increased by about 5% from 85% to 90%, for 15-19 it increased by 5% from 80% to 85% and for 20-24, it remained the same at 68%.

 

Insurance coverage for race between 1999-2008:  White/non-Hispanic increased from 85% to 89%.  Black/non-Hispanic increased from 80% to 81%.  Hispanic Latino increased from 66% to 67%.  Asian populations increased from 80% to 86%.  Native Hawaiian or other Pacific Islander decreased from 81% to 78%.  American Indian or Alaskan Native increased from 61% to 71%.

 

Persons with a usual primary care provider for 2007:

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Colorectal cancer (CRC); 4/26/16 http://closingthehealthgap.org/colorectal-cancer-crc-42616/ http://closingthehealthgap.org/colorectal-cancer-crc-42616/#comments Tue, 26 Apr 2016 13:11:06 +0000 Matt Vander Laan http://closingthehealthgap.org/?p=6257

 

Colorectal cancer (CRC)

http://www.ncbi.nlm.nih.gov/pubmed/27034811

Jackson S. Christian, Oman Matthew, Patel M. Aatish, Vega J. Kenneth. Health Disparities in colorectal cancer among racial ethnic minorities in the United States. Journal of Gastrointestinal Oncology. 2016 April 7; 7(suppl 1): s32-s43.

2010 census: 1/3 US population-indentified as something other than non-Hispanic white.

Incidence and moratlity disparities remain among African Americans and whites.  CRC mortality for whites has decreased the most compared to all other races. Decreased in African Americans as well, but still higher than all other races.  Biggest disparity is ...

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Colorectal cancer (CRC)

http://www.ncbi.nlm.nih.gov/pubmed/27034811

Jackson S. Christian, Oman Matthew, Patel M. Aatish, Vega J. Kenneth. Health Disparities in colorectal cancer among racial ethnic minorities in the United States. Journal of Gastrointestinal Oncology. 2016 April 7; 7(suppl 1): s32-s43.

2010 census: 1/3 US population-indentified as something other than non-Hispanic white.

Incidence and moratlity disparities remain among African Americans and whites.  CRC mortality for whites has decreased the most compared to all other races. Decreased in African Americans as well, but still higher than all other races.  Biggest disparity is among the distant stage CRC.  28% difference in incidence in diagnosis of disant stage CRC between AA and nHw.  (AA-African American, nHw- non Hispanic whites). This difference accounts for more than 60% of total mortality disparity from CRC. (from Robbins et.al).  Results from- screening and family history. Envrionmental risk factors play major role (account for about 65%), factors like smoking, obesity, and alcohol use to name a few.  Disparities in treatment:   djuvant chemotherapy, physical activity and diet play significant roles in affecting mortality post-op. AA may be less likely to receive newer chemotherapeutic agents and are less likely to be treated in high quality or high volume facilities, which have better outcomes. AA mistrust of medical research and researchers as their primary resistance to participation in medical research resulting in decreased participation in clinical trials.  Understanding family history: AA are less likely to know their paternal history; AA less likely to tell family relatives about the findings of the disease. (reason being that those with a family history or the disease are at a much higher risk) Screening disparities: screening for CRC in AA is behind that for nHw. Almost double the amount of AA are diagnosed with CRC before the recommended screening age of 50 (10.6%) compared to nHw (5.5%). Recent study found that AA were less likely to undergo screening and colonoscopy that nHw. Decreased trust in health care so less health care encountersLess likely to continue continuity of care and more likely to be uninsured.

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