Download Women`s Health Disparities

Women’s Health Disparities
Health Disparities and Cultural
Competence SIG Webinar Series
April 16, 2013
Natalie A. DiPietro, PharmD, MPH
Ohio Northern University
Raabe College of Pharmacy
[email protected]
Objectives
1. List examples of current women’s health
disparities in the United States.
2. Identify the root cause(s) of these
disparities.
3. Describe recommendations for healthcare
professionals (HCPs) to reduce or eliminate
women’s health disparities.
Definition
• “Health disparities are differences in the
incidence, prevalence, mortality, and
burden of diseases and other adverse
health conditions that exist among specific
population groups in the United States.”
(National Institute of Health, 1999)
A National Priority
• Healthy People 2020
– 1 of 4 main goals:
“Achieve health equity, eliminate
disparities, and improve the health of
all groups.”
Women’s Health Disparities
• Sources of information:
– Agency for Healthcare Research and Quality
http://www.ahrq.gov/research/findings/nhqrdr/
nhqrdr10/women.html
– Centers for Disease Control and Prevention
http://www.cdc.gov/minorityhealth/omhhe.html
#Goals
– Kaiser Family Foundation
http://www.statehealthfacts.org/women.jsp
N.B.: This list is not exhaustive
Examples
1. Infant and maternal mortality
2. Breast cancer
3. Cardiovascular disease
Disparities in U.S. Infant Mortality
MacDorman MF & Mathews TJ, 2011
Disparities in U.S. Maternal Mortality
National Vital Statistics Report, 2010
Number of new cases of invasive cancer and deaths
per year per 100,000 U.S. women, 2000-2004
Racial/Ethnic Group Incidence Death
All
Black
Asian/Pacific Islander
127.8
118.3
89
25.5
33.8
12.6
Hispanic
American Indian/
Alaska Native
White
89.3
16.1
69.8
16.1
132.5
25
National Cancer Institute, 2008
Cardiovascular Disease (CVD)
• Leading cause of death for U.S. men and
women
– Lifetime incidence is nearly 1 in 2 women
• Differences between men and women
– Age of onset
– Presentation/symptoms
– Outcomes
AHA, 2013; Mosca L, et al, 2007; CDC, 2009
• Data indicate persistent lack of knowledge
and intervention for CVD among women
– 55% of women know that CVD is the leading
cause of death for both sexes
– Nearly 40% do not perceive themselves to be
at risk
– 25% of women surveyed indicated their
healthcare provider had not emphasized that
heart health was important
– 20% relayed they had not been clearly told how
they can change their risk status
Mosca L, et al, 2006
Root causes of health disparities
ACS, 2004; IOM, 2003; Freeman, 2004; NPA, 2010; National Business Group on Health, 2009
IOM Report Unequal Treatment: Confronting
Racial and Ethnic Disparities in Healthcare
(2003):
– Patient-Level Variables
– Healthcare Systems-Level Factors
– Care Process-Level Variables
Patient-Level Variables
Socioeconomic status (SES)
•
•
•
•
Lack of resources and/or knowledge
Risk-promoting behaviors
Disproportionate environmental exposures
Access to care
Cultural issues
• Cultural beliefs and preferences can impact health
status and influence healthcare decisions
Genetics
• Biological or inherited characteristics contribute less
to disparities than SES factors
Healthcare Systems-Level Factors
Language barriers
• Result in issues in access to care and in healthcare
delivery
Low health literacy
• According to AHRQ, only 12% of U.S. adults have
proficient health literacy skills
Geographical barriers
• Location of facilities, resource constraints
Care Process-Level Variables
Patient-provider misunderstanding and/or
miscommunication
• Bias, stereotyping, uncertainty
• HCPs may have assumptions about patients
• Patients may have assumptions about HCPs
Combination of these variables
• Many times, there is overlap between these attributes
Source: Cancer Facts and Figures,
2004. Figure used with permission
from the American Cancer Society
Recommendations for HCPs
Poll question
List one way that HCPs can reduce
women’s health disparities. free text response
Healthcare providers, communities, and public
health agencies must become partners to:
Increase education and
health literacy
• Individual and community level
• Encourage patients to modify risk
behaviors
• Promote EBM primary prevention
Tailor programs to meet the
needs of a diverse
population
• Formulary decisions; consistent
use of EBM guidelines
• Consistent use of multidisciplinary
teams
• Appropriate services
Perform outreach and
increase access to care
• Improve early disease detection
through screening
• Organize and sponsor outreach
events
• Increase advocacy at federal, state,
and local levels
Conduct research
• Identify & address barriers to
equitable health; target resources
• Share best practices & lessons
learned
• Enroll diverse patients in clinical
trials
CDC, 2007; ACS, 2004; CRCHD, 2004; ASHP, 2008;
NPA, 2010
Poll Question
What do you think is/are the most effective
way(s) to teach pharmacy students about
women’s health disparities? select all that apply
1. Didactic curriculum
2. IPPEs/APPEs
3. Service learning
“Any effort to increase the use of preventive
services and improve women’s health status
must be interprofessional in nature and
include pharmacy as one of the targeted
health professions.”
~ U.S. Department of Health and Human
Services (HHS), Health Resources and
Services Administration (HRSA), Office of
Women's Health (OWH), American Association
of Colleges of Pharmacy (AACP)
References
• American Heart Association (AHA). Gender and Heart Disease,
2013. http://www.goredforwomen.org/know-your-risk/find-out-yourrisk/gender-heart-disease/
• American Cancer Society (ACS). Cancer Facts & Figures 2004.
Atlanta: American Cancer Society.
• American Society of Heath-Systems Pharmacists (ASHP).
Statement on Racial and Ethnic Disparities in Health Care, 2008.
www.ashp.org/DocLibrary/BestPractices/SpecificStDisparities.aspx
• Centers for Disease Control and Prevention (CDC). Health
Disparities in Cancer, 2007
http://www.cdc.gov/cancer/healthdisparities/
• CDC. Leading causes of death in females, United States, 2009.
http://www.cdc.gov/women/lcod/
• Center to Reduce Cancer Health Disparities (CRCHD),
National Cancer Institute. http://crchd.cancer.gov/
• Freeman HP. Poverty, Culture, and Social Injustice:
Determinants of Cancer Disparities. CA Cancer J Clin.
2004;54:72-77.
• Institute of Medicine (IOM). Unequal Treatment: Confronting
Racial and Ethnic Disparities in Health Care, 2003.
www.iom.edu/?id=16740
• MacDorman MF, Mathews TJ. Understanding racial and ethnic
disparities in U.S. infant mortality rates. NCHS data brief, no
74. Hyattsville, MD: National Center for Health Statistics. 2011.
• Mosca L, Banca CL, Benjamin EJ, et al. Evidence-based
guidelines for cardiovascular disease prevention in women:
2007 update (American Heart Association Guidelines). J Am
Coll Cardiol. 2007;49:1230-1250.
• Mosca L, Mochari H, Christian A, et al. National study of women’s
awareness, preventive action, and barriers to cardiovascular
health. Circulation. 2006;113:525-534.
• National Business Group on Health. Eliminating Racial and Ethnic
Health Disparities; A Business Case Update for Employers, 2009.
http://minorityhealth.hhs.gov/Assets/pdf/checked/1/Eliminating_R
acial_Ethnic_Health_Disparities_A_Business_Case_Update_for_
Employers.pdf
• National Cancer Institute (NCI). Cancer health disparities.
http://www.cancer.gov/cancertopics/factsheet/disparities/cancerhealth-disparities#5
• National Partnership for Action to End Health Disparities (NPA),
U.S. Department of Health and Human Services.
http://minorityhealth.hhs.gov/npa/
• National Vital Statistics Report, 2010. Deaths: Final data for 2007.
http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf
Questions/Discussion
Women’s Health Disparities
Health Disparities and Cultural
Competence SIG Webinar Series
April 16, 2013
Natalie A. DiPietro, PharmD, MPH
Ohio Northern University Raabe College of Pharmacy
[email protected]