Download Behavioral Health Disparities

Lorraine Moya Salas, PhD
Bianca Altamirano, MSW
 Those
challenged by poverty experience the
poorest health.
 Racial and ethnic minorities experience poorer
health relative to national averages from birth
to death
• Higher infant mortality
• Higher rates of disease and disability
• Shortened life expectancy
 Health
inequalities are a result of both
socioeconomic advantage and
race/ethnicity independently and in
combination.
“One thing of course we must expect to
find, and that is a much higher death rate
at present among Negroes than among
whites. This is one measure of the
difference in their social advancement…”
~ W. B. DuBois~
 Health
status is a reflection of a myriad of
factor including personal choices,
historic disadvantage and persistent
social inequalities.
 Conditions
that foster disparities:
“Social determinants of health are life-enhancing
resources such as food supply, housing,
economic, and social relationships,
transportation, education, and health care whose
distribution across populations effectively
determines length and quality of life.”
 Upstream
determinants – change policies
and environmental conditions to promote
health.
 Downstream
determinants – interventions
 Behavioral
health disorders are
comparable across racial and ethnic
groups yet ethnic and racial groups are
more adversely impacted by their
conditions.
 American
Indians have a heightened risk
for PTSD and alcohol dependence.
 Higher rates of schizophrenia in the
African American community.
 Latino/African American youth have
higher rates of PTSD.
 Higher rates of psychological symptoms
 Social
determinants influence the onset
and progression of health and mental
health conditions.
• Environment plays a larger role in the onset of
conditions
• Progression of conditions are impacted more so
by access and quality of care.
 Physical
health and mental health are
interconnected.
 Emphasis of interventions may differ but
to achieve health – “a state of complete
physical, mental, and social well-being
and not merely the absence of disease”
we must attend to social determinants
within and outside health care systems.
 Resilience
- successful adaptation
despite threatening circumstances,
wellness in spite of significant risk.
RISK FACTORS
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Poverty
Community
disorganization/violence
Inadequate schools
Trauma - racism
Low birth weight
Genetic vulnerability
Family conflict
Maternal mental disorder
Dysfunctional childrearing
environment
Chronic health conditions
PROTECTIVE FACTORS
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Hope/optimism
Social competence
Support family
relationships
Parental
structure/monitoring
Caring schools
Availability of resources
Social norms
Sense of community
Spirituality/Religion
Bicultural orientation
Direct and Indirect
Poor
physical
health
Poor
mental
health
Substance
Use
Downward
Model
Race
Environmental
Conditions
Disease
Neighborhood
Conditions
Poverty
Depression
Stress hormone
dynamics (cell
survival)
Tumor
development
 Underutilization
of services
• Socioeconomics (lack health insurance,
•
•
•
•
geographic factors)
Provider bias
Communication barriers
Lack of diversity among providers
Distrust, stigma, alternative health practices
 Comprehensive
community interventions
 Community Health Workers/Promotoras
 Integrated Care/Collaborative Care
Models
 Culturally tailored evidenced-based
interventions
 Effective
in changing environmental
conditions that are linked to chronic
physical and mental health conditions
 Limited research on effectiveness of
specific community interventions.
 Best available evidence
Social Determinants of Health
Interventions
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Outcomes
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Policies
Programs
Prevention Interventions
Health Literacy
Behavioral outcomes
Specific risk factors
Health-related quality of life
Health equity
Assessment, evaluation,
and dissemination
(Adapted from Healthy People
2020)
http://www.youtube.com/user/interculturalvide
o?blend=4&ob=5#p/u/3/y1SeLM2crUs
 “Lay
members of communities who work
either for pay or as volunteers in
association with the local health care
system in both urban and rural
environments and usually share ethnicity,
language, socioeconomic status, and life
experiences with the community they
serve.”
 Improve
health care access/utilization,
increase health knowledge, and the
health status of people of color.
 Play a role in changing community
conditions.
 “The
systematic coordination of physical
and behavioral health services”
• Co-location
• Coordination
• Engage consumers in the treatment process
• Evidence-based guidelines
 Both
empirically supported treatments
and culturally adapted interventions are
effective.
 Preference findings, engagement, and
retention.
 Cultural considerations
• Historical trauma
• Acculturation
 Whole-stream
 Holistic
interventions
health
 Evidence based practice and culturally
adapted/culturally supported
interventions