Question

Analyze the health status of a specific minority group. Select a minority group that is represented in the United States (examples include American Indian/Alaskan Native, Asian American, Black or African American, Hispanic or Latino, Native Hawaiian, or Pacific Islander).

In an essay of 750-1,000 words, compare and contrast the health status of the minority group you have selected to the national average. Consider the cultural, socioeconomic, and sociopolitical barriers to health. How do race, ethnicity, socioeconomic status, and education influence health for the minority group you have selected? Address the following in your essay:

What is the current health status of this minority group?

How is health promotion defined by this group?

What health disparities exist for this group?

Describe at least one approach using the three levels of health promotion prevention (primary, secondary, and tertiary) that is likely to be the most effective given the unique needs of the minority group you have selected. Provide an explanation of why it might be the most effective choice.

Cite a minimum of three references in the paper.

You will find important health information regarding minority groups by exploring the following Centers for Disease Control and Prevention (CDC) links:

Minority Health: http://www.cdc.gov/minorityhealth/index.html

Racial and Ethnic Approaches to Community Health (REACH): http://www.cdc.gov/chronicdisease/resources/publications/aag/reach.htm

Racial and Ethnic Minority Populations: http://www.samhsa.gov/specific-populations/racial-ethnic-minority

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Answer 1

Overview (Demographics): In July 2015, 40.7 million people in the United States were black alone, which represents 12.7 percent of the total population. African Americans are the second largest minority population, following the Hispanic/Latino population. In 2015, most blacks lived in the South (58 percent of the black U.S. population), while 35 percent of the white population lived in the South. The ten states with the largest black population in 2015 were Texas, Florida, Georgia, New York, California, North Carolina, Illinois, Maryland, Virginia, Louisiana. Combined, these 10 states represent 59% of the total black population. Of the 10 largest places in the United States with 100,000 or more population in 2010, Detroit, Michigan had the largest proportion of blacks (84%), followed by Jackson, Mississippi (80%).

Educational Attainment: In 2015, as compared to non-Hispanic whites 25 years and over, a lower percentage of non-Hispanic blacks had earned at least a high school diploma (84.8 percent and 92.3 percent, respectively). 20.2 percent of non-Hispanic blacks have a bachelor’s degree or higher, as compared with 34.2 percent of non-Hispanic whites. More black women than black men had earned at least a bachelor's degree (22.4 percent compared with 17.7 percent), while among non-Hispanic whites, a higher proportion of men than women had earned at least a bachelor's degree (34.4 percent and 34.0 percent, respectively).

Economics: According to a 2015 Census Bureau report, the average non-Hispanic black household median income was $36,515 in comparison to $61,394 for non-Hispanic white households. In 2015, the U.S. Census Bureau reported that 25.4 percent of non-Hispanic blacks in comparison to 10.4 percent of non-Hispanic whites were living at the poverty level. For 2015, the unemployment rate for blacks was twice that for non-Hispanic whites (11.4 percent and 5.0 percent, respectively). This finding was consistent for both men and women.

Insurance Coverage: In 2015, 54.4 percent of non-Hispanic blacks in comparison to 75.8 percent of non-Hispanic whites used private health insurance. Also in 2015, 43.6 percent of non-Hispanic blacks in comparison to 32.7 percent of non-Hispanic whites relied on Medicaid, public health insurance. Finally, 11.0 percent of non-Hispanic blacks in comparison to 6.3 percent of non-Hispanic whites were uninsured.

Health Conditions: The death rate for African Americans was generally higher than whites for heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, HIV/AIDS, and homicide.

Health Disparities Experienced by Black or African Americans --- United States

In the 2000 census, 36.4 million persons, approximately 12.9% of the U.S. population, identified themselves as Black or African American; 35.4 million of these persons identified themselves as non-Hispanic (1). For many health conditions, non-Hispanic blacks bear a disproportionate burden of disease, injury, death, and disability. Although the top three causes and seven of the 10 leading causes of death are the same for non-Hispanic blacks and non-Hispanic whites (the largest racial/ethnic population in the United States), the risk factors and incidence, morbidity, and mortality rates for these diseases and injuries often are greater among blacks than whites. In addition, three of the 10 leading causes of death for non-Hispanic blacks are not among the leading causes of death for non-Hispanic whites: homicide (sixth), human immunodeficiency virus (HIV) disease (seventh), and septicemia (ninth) (Table). This week's MMWR is the third in a series* focusing on racial/ethnic health disparities. Eliminating these disparities will require culturally appropriate public health initiatives, community support, and equitable access to quality health care.

In 2002, non-Hispanic blacks who died from HIV disease had approximately 11 times^† as many age-adjusted years of potential life lost before age 75 years per 100,000 population as non-Hispanic whites. Non-Hispanic blacks also had substantially more years of potential life lost than non-Hispanic whites for homicide (nine times as many), stroke (three times as many), perinatal diseases (three times as many), and diabetes (three times as many) (2).

Cancer is the second leading cause of death for both non-Hispanic blacks and non-Hispanic whites (Table). However, in 2001, the age-adjusted incidence per 100,000 population was substantially higher for black females than for white females for certain cancers, including colon/rectal (54.0 versus 43.3), pancreatic (13.0 versus 8.9), and stomach (9.0 versus 4.5) cancers. Among males, the age-adjusted incidence was higher for black males than for white males for certain cancers, including prostate (251.3 versus 167.8), lung/bronchus (108.2 versus 72.8), colon/rectal (68.3 versus 58.9), and stomach (16.3 versus 10.0) cancers (3).

Stroke is the third leading cause of death for both non-Hispanic blacks and non-Hispanic whites (Table). However, during 1999--2002, non-Hispanic black males and females aged 20--74 years had higher^† age-adjusted rates per 100,000 population of hypertension than their white counterparts (36.8 versus 23.9 for males; 39.4 versus 23.3 for females) (4).

Racial/ethnic health disparities are reflected in leading indicators of progress toward achievement of the national health objectives for 2010 (5). In 2002, non-Hispanic blacks trailed non-Hispanic whites in at least four positive health indicators^†, including percentages of 1) persons aged <65 years with health insurance (81% of non-Hispanic blacks versus 87% of non-Hispanic whites), 2) adults aged >65 years vaccinated against influenza (50% versus 69%) and pneumococcal disease (37% versus 60%), 3) women receiving prenatal care in the first trimester (75% versus 89%), and 4) persons aged >18 years who participated in regular moderate physical activity (25% versus 35%). In addition, non-Hispanic blacks had substantially higher proportions of certain negative health indicators than non-Hispanic whites, including 1) new cases of gonorrhea (742 versus 31 per 100,000 population; 2002 data), 2) deaths from homicide (21.6 versus 2.8; 2002 data), 3) persons aged 6--19 years who were overweight or obese (22% versus 12%; 2000 data), and 4) adults who were obese (40% versus 29%; 2000 data).

Since the 1970s, racial/ethnic disparities in measles cases and measles-vaccine coverage have been all but eliminated (6). However, during 1996--2001, the vaccination-coverage gap between non-Hispanic white and non-Hispanic black children widened by an average of 1.1% each year for children aged 19--35 months who were up to date for the 4:3:1:3:3 series of vaccines (recommended to prevent diphtheria, tetanus, and pertussis; polio; measles; Haemophilus influenzae type b disease; and hepatitis B) (7). In 2002, among children aged 19--35 months, 68% of non-Hispanic black children were fully vaccinated, compared with 78% of non-Hispanic white children.

Editorial Note:

Multiple factors contribute to racial/ethnic health disparities, including socioeconomic factors (e.g., education, employment, and income), lifestyle behaviors (e.g., physical activity and alcohol intake), social environment (e.g., educational and economic opportunities, racial/ethnic discrimination, and neighborhood and work conditions), and access to preventive health-care services (e.g., cancer screening and vaccination) (8). Recent immigrants also can be at increased risk for chronic disease and injury, particularly those who lack fluency in English and familiarity with the U.S. health-care system or who have different cultural attitudes about the use of traditional versus conventional medicine. Approximately 6% of persons who identified themselves as Black or African American in the 2000 census were foreign-born.

For blacks in the United States, health disparities can mean earlier deaths, decreased quality of life, loss of economic opportunities, and perceptions of injustice. For society, these disparities translate into less than optimal productivity, higher health-care costs, and social inequity. By 2050, an estimated 61 million black persons will reside in the United States, amounting to approximately 15% of the total U.S. population (9).

To promote consistency in measuring progress toward achieving the national health objectives, a workgroup appointed by the U.S. Department of Health and Human Services (DHHS) has recommended that 1) progress toward eliminating disparities for individual subpopulations be measured by the percentage difference between each subpopulation rate and the most favorable or best subpopulation rate in each domain and 2) all measures be expressed in terms of adverse events (10). DHHS conducts periodic reviews to monitor progress toward achieving the national health objectives, and progress toward elimination of health disparities is part of those reviews.

Promoting Health Care status of Black Americans;

Two concepts emerge that are of overarching importance for the design of programs, including prevention programs, designed to serve minority populations. These include use of a marketing perspective and community legitimacy.

Marketing strategies. Health behavior-change strategies must involve "social marketing."18 To reach minority populations effectively with prevention information requires messages and programs that are tailored for and targeted to reach a specific audience. These marketing considerations require attention to socioeconomic and cultural variations. Such variations influence choices of messages and messengers, reflecting a variety of countries of origin, use of languages other than English, preferences for specific media and formats, use of multiple channels for transmission of information, framing that information to reflect differences in value systems and varying age structure of populations, and accommodation to subtle regional variations.19 The U.S. advertising industry has been quick to understand and exploit the segmentation of markets using a complex mix of demographic factors, designing specifically tailored messages for each segment of the market. The health community should use the expertise of the advertising industry as it begins to think seriously about how to influence health behavior. However, the extensive training and education of health professionals often leads them to overemphasize behavior change that occurs cognitively by provision of information, particularly written materials. Moreover, our American values also influence the framing of prevention messages. In this country, we highly value self-reliance and place substantial responsibility for life choices on the individual Given this mind-set, destructive behavior patterns that are often encountered in poor urban populations, such as teenage pregnancy, noncompliance with physicians' treatment regimens, drug use during pregnancy, and interpersonal violence, are viewed as not only detrimental to health, but morally wrong. The marketing perspective would lead us to deal with this behavior pragmatically but not judgmentally. However, belief in the power of cognitive information and individual responsibility—the value system overlay—must be recognized before pragmatic ameliorative solutions can be crafted. Otherwise, solutions tend to become entangled with inchoate inclinations to punish.

Community legitimacy. In a community-based prevention program, community legitimacy can be achieved by including mechanisms to allow communities to buy into the goals and content of the program. This is particularly critical in light of the problem of alienation I mentioned earlier. Mechanisms that can foster community legitimacy include the use of minority health professionals in the design of programs, the use of program governing boards with broadly representative membership, and full involvement of community representatives from the beginning of the project.

Focus Of Prevention Activities: To better categorize the challenges we face in health promotion/ disease prevention among minority populations, it is also useful to distinguish different spheres in which prevention activities may be focused: communitywide health information communication, screening/ preventive services, and the physician/patient relationship.

Communicating health information in the community:. Minority communities are exposed to many of the general health messages to which the rest of the population is exposed—antismoking messages, the emphasis on fitness, concerns over high-fat diets, and messages regarding substance abuse. However, the effect of these generic health messages on minority populations is likely to be minimal unless reinforced by more specific ones that are perceived to be more personally ''relevant'' to minority Americans. Because of the emergency nature of the human immunodeficiency virus (HIV) epidemic, the necessity to specifically tailor communitywide prevention information to minorities has received much more attention in the past three years. This has become particularly urgent as the rates of AIDS due to those HIV transmission categories in which blacks and Hispanics predominate are increasing at more rapid rates than in those HIV transmission patterns in which whites and minorities have similar rates of AIDS. The principles that have become accepted for communitywide HIV prevention information for minority populations are equally valid for prevention of other diseases among minority populations. These principles include the importance of seeking credible messengers, tailoring messages so that they are culturally sensitive and appropriate, combining national campaigns with locally based ones to personalize the message, and considering the educational levels of target populations. Screening/preventive services: Because screening and preventive services often are provided outside the physician's office, these services need to be examined separately from prevention in the context of the physician/patient dyad. Poor populations frequently make use of a wide variety of publicly provided screening and prevention services often carried out in separate clinics for sexually transmitted diseases, maternal and child health services, drug treatment, and mental health. This results in fragmentation of services—one of the most problematic elements of health care delivery to disadvantaged populations. This fragmentation has especially pernicious effects since disadvantaged people are already burdened with excess disease, have the least skills to navigate a complicated bureaucracy, and face continual pressures to meet the needs of dayto-day life; all of these already mitigate against a focus on prevention.

Physician/patient relationship: Minorities have substantially lower rates of health insurance, which is the minimal "ticket" for access to the health care system. Moreover, even for those minorities who are insured, that insurance is disproportionately likely to be Medicaid, which reimburses so poorly for physician visits that many Medicaid patients enter the health care system only when an emergency occurs. Therefore, fragmentation of services is more destructive to minorities because they are more likely than whites to lack a usual source of care. Prevention services as well as optimal management of chronic disease are more likely to occur in the context of a long-standing relationship with a physician. Thus, minority populations who have little contact with the health care system between illnesses are even less likely to receive primary, secondary, or tertiary preventive care.

Minority Health Care status in the US

There is a growing realization among healthcare researchers, clinicians, and advocates that a focus on health care disparities is an important aspect of improving healthcare outcomes and that activities toward improvement must bring together many elements of our healthcare delivery system. The populations that have customarily been underserved in the American health care system include African Americans, Latinos, Native Americans, and Asian Americans.[1]

Defining Health Disparities

The term "health disparities" is often defined as "a difference in which disadvantaged social groups such as the poor, racial/ethnic minorities, women and other groups who have persistently experienced social disadvantage or discrimination systematically experience worse health or greater health risks than more advantaged social groups." When this term is applied to certain ethnic and racial social groups, it describes the increased presence and severity of certain diseases, poorer health outcomes, and greater difficulty in obtaining healthcare services for these races and ethnicities. When systemic barriers to good health are avoidable yet still remain, they are often referred to as "health inequities.

An understanding of how race, ethnicity, geography, education, and income impact one’s access to health services can provide valuable insight to health policy experts and advocates. Learning more about these disparities can be a way of lessening these kinds of inequalities. An analysis of the root causes of racial and ethnic disparities and what can be done to eliminate them can serve this end goal. Below are discussions of specific poorer health outcomes and ethnic and racial disparities which can be a result of social determinants. It is important to address how racial and ethnic disparities are not only morally wrong and fiscally unwise, but stress our health infrastructure, including programs such as Medicare and Medicaid.

The Elimination of Racial and Ethnic Health Disparities Would Save the U.S. Health Care System Billions of Dollars Annually

A 2011 study estimates that the economic costs of health disparities due to race for African Americans, Asian Americans, and Latinos from 2003 thru 2006 was a little over $229 billion.^[4] In a report issued in September, 2009, the Urban Institute calculated that the Medicare program would save $15.6 billion per year if health disparities were eliminated. The study examined a select set of preventable diseases among the Latino and African American communities, including diabetes, hypertension and stroke, and concluded that – if the prevalence of such diseases in the African American and Latino communities were reduced to the same prevalence as those diseases occur in the non-Latino white population – $23.9 billion in health care costs would be saved in 2009 alone.^[5]  

As the representation of Latinos and African Americans in the general population increases, health care costs could be reduced even further by addressing racial and ethnic health disparities. Therefore, in addition to the compelling ethical and moral reasons to eliminate health disparities, there are economic reasons to do so as well.

Poverty, Race, and Ethnic Background Affect Access to Health Care and the Quality of Health Care

An examination of these disparities at the local and national levels is important in order to highlight the widespread nature of these health inequities.

At the national level, African American men, for instance, are more likely to die from cancer than Caucasian men.[6] While Caucasian women are more likely to develop breast cancer than African-American women, the latter are more likely to die from this particular form of cancer than Caucasian women.[7] While Caucasian men are more likely to develop colorectal cancer than African-American men, the latter are more likely to die from this cancer than the former.[8] On the other hand, African-American men are more likely than Caucasian men to develop prostate cancer.[9] The underlying causes of these disparities are socio-economic policies, health access issues among African-Americans which Caucasian persons are less likely to encounter, as well as a lack of health education.

Among America’s minority populations, race, ethnicity, and poverty are more pronounced than among Caucasian Americans. According to the US Census Bureau, in 2013, 25 percent of Hispanics, 11 percent of persons of Asian descent, and 27 percent of African Americans lived in poverty while only 12 percent of Caucasians lived in poverty.[10] Moreover, the more impoverished one is, the more likely it is that one cannot afford health insurance. In 2012, 23 percent of “poor” and 24 percent of “lower-income” persons in the US lacked health insurance.In 2012, 26 percent of Native American/Alaska Natives, 18 percent of African Americans, 16 percent of persons of Asian descent, and 12 percent of native Hawaiian/Pacific Islanders lacked health insurance. In a 2013 study of the non-elderly uninsured, 32 percent of all Hispanics, 14 percent of all African Americans, and 6 percent of all Americans of Asian/Pacific Islander descent reported they lacked health insurance. The same study looked at all non-elderly, uninsured Americans and found that 71 percent of this population had 1 or more full time workers in the family.

The costs of health care in the United States may also impoverish many American citizens. According to a recent report, 62 percent of persons who filed bankruptcy in 2007 did so as a result of medical expenses.

Minnesota’s 2014 Health Equity Report highlights the disparate mortality rates of various races broken down by age group per 100,000 persons between the years of 2007 and 2011. For the 45 to 64 age group, 772 African American, 1,063 Native Americans, 325 persons of Asian descent, and 434 Caucasian persons died per 100,000 persons.[14] Data from Rhode Island during the years 2011-13 shows the disparities which Hispanics and African Americans face. While 41 percent of Latinos 26 percent of African Americans reported having not having any health insurance during this time, 13 percent of Caucasians in Rhode Island reported the same information.[15] While 31 percent of Hispanics and 22 percent of Native Americans in Rhode Island reported not being able to afford seeing a health care provider during this period, 12 percent of Caucasians reported the same information.[16] The National Center for Health Statistics reported in March 2015 that African-American and Latino children are almost twice as likely as Caucasian children to have untreated tooth decay in primary teeth.[17]

The numbers of Hispanics with health insurance differs nationally. In 2012, the number of uninsured Hispanics was 29 percent and in 2013 this number dipped to 24 percent.[18]

Unaddressed Language Barriers Affect Health Outcomes and Access to Medical Care

Without effective health provider and patient communication in a language both can understand, there is an increased risk of misdiagnosis, misunderstanding about the proper course of treatment and poorer adherence to medication and discharge instructions. Health care providers from around the country have reported language difficulties and inadequate funding of language services to be major barriers to access to health care for limited English proficiency individuals and a serious threat to the quality of care they receive. In one study, over one quarter of limited English proficient patients who needed, but did not get, an interpreter reported that they did not understand their medication instructions. By comparison only 2 percent of those patients who did not need an interpreter, and 2 percent of those who needed an interpreter and received one, did not understand their medication instructions.

Children suffer from racial and ethnic health disparities

According to census figures published in 2012, 50.4 percent of all US children (31.8 million children) are identified as belonging to a racial or ethnic minority. Certain disparities in health access and outcomes are particularly noticeable for children of specific racial/ethnic minorities relative to the population at large: for Latino children, suboptimal health status and teeth conditions and problems getting specialty care; for African American children, asthma, behavior problems, skin allergies and unmet prescription needs; for Native American and Alaska Native children, hearing/visual problems, no usual source of care and unmet medical/dental needs; and for Asian/Pacific Islander children, problems getting specialty care and not seeing a doctor for the past year. According to the 2013 US Census, around 11-12 percent of persons under age 19 with household incomes less than $50,000 per annum were without health insurance. 27 percent of non-native born persons under 19 were without health insurance in 2013. During that same year, 12 percent of Hispanics under the age of 19, 7 percent of African Americans under the same age, and 8 percent of persons under the age of 19 of Asian descent lacked health insurance.[26]

Children suffer from racial and ethnic health disparities

According to census figures published in 2012, 50.4 percent of all US children (31.8 million children) are identified as belonging to a racial or ethnic minority. Certain disparities in health access and outcomes are particularly noticeable for children of specific racial/ethnic minorities relative to the population at large: for Latino children, suboptimal health status and teeth conditions and problems getting specialty care; for African American children, asthma, behavior problems, skin allergies and unmet prescription needs; for Native American and Alaska Native children, hearing/visual problems, no usual source of care and unmet medical/dental needs; and for Asian/Pacific Islander children, problems getting specialty care and not seeing a doctor for the past year. According to the 2013 US Census, around 11-12 percent of persons under age 19 with household incomes less than $50,000 per annum were without health insurance. 27 percent of non-native born persons under 19 were without health insurance in 2013. During that same year, 12 percent of Hispanics under the age of 19, 7 percent of African Americans under the same age, and 8 percent of persons under the age of 19 of Asian descent lacked health insurance.[26]

Obesity and Chronic Health Conditions Are Caused in Part by Inadequate Access to Fresh Food

According to a 2012 study, nearly 19 percent of all African American adults over the age of 20 have diagnosed or undiagnosed diabetes. Additionally, African Americans are 77 percent more likely than non-Hispanic Caucasian Americans to develop diabetes. On the other hand, nearly 12 percent of Hispanic Americans have diagnosed or undiagnosed diabetes and Hispanics are 66 percent more likely than non-Hispanic Caucasians to have diabetes.[

It has been established that public health strategies designed to improve social and physical environments to create conditions for healthful eating and physical activity can be, in addition to clinical treatment, beneficial for those who are already obese.[28] As an example, "innovative public policy approaches include a variety of policy and environmental initiatives designed to increase fruit and vegetable consumption in underserved areas."[29] Thus, elimination of "food deserts" (see below) in underserved communities can help eliminate chronic diseases, such as diabetes, and help achieve greater equity in health outcomes among racial and ethnic minorities