Bridget DillonMarch 18, 2013

Health Equity

Defining Health Equity

• Generally used in a political context

• Considered a priority for WHO, ACA

• Equal access to health care and level of care• Both primary and advanced care• Requires affordability• Lots of locations• Uniform standard of care• Uniform results of care across race, age, gender, socioeconomic

class, level of education

Defining Health Equity• In the United States, there are disparities in health and access to care based

on:• Race• Income• Residence• Level of education

Measurements of Health Equity• Health equity is the absence of unfair and avoidable or remediable

differences in health services and outcomes among groups of people. (WHO)

• Some of the statistics used include:• Mortality Rates• Access to professional health personnel• Access to pre-natal care• Vaccinations

• http://www.who.int/gho/map_gallery/en/

Healthy People 2020• Goal: Improve access to comprehensive, quality health care service

• Objectives:• Increase the proportion of persons with health insurance• Increase the number of practicing primary care providers• Increase the proportion of persons who have a specific source of

ongoing care• Reduce the proportion of persons who are unable to obtain or

delay in obtaining necessary medical care, dental care, or prescription medicines

• Increase the proportion of persons who receive appropriate evidence-based clinical preventative services

• Increase the proportion of persons who have access to rapidly responding prehospital emergency medical services

• Reduce the proportion of hospital emergency department visits in which the wait time to see an emergency department clinician exceeds the recommended time frame

Where are we starting from?

• http://apps.nccd.cdc.gov/DHDSPAtlas/viewer.aspx

• http://apps.nccd.cdc.gov/cdi/

• http://apps.nccd.cdc.gov/HRQOL/

• http://www.statehealthfacts.org/

Where are we starting from?

Health DisparitiesCancer Deaths 2004: overall cancer death rate was 1.2 times higher among African

Americans than among Whites

Diabetes2005: Native Hawaiians/PI (15.4%), AI/AN (13.6%), AA (11.3%), Hispanics/Latinos (9.8%) were all significantly more likely to have been diagnosed with diabetes compared to their White counterparts (7%)

HIV/AIDSAfrican Americans, who comprise approximately 12% of the US population, accounted for half of the HIV/AIDS cases diagnosed between 2001 and 2004

Tooth Decay

2001-2004: more than twice as many children from poor families experienced a greater number of untreated cavities than children from non-poor familiesOf those children living below 100% of poverty level, Mexican American children (35%) and AA children (26%) were more likely to experience untreated cavities than White children (20%)

Table adapted from Brennan Ramirez LK, et al., 2008

Health Disparities

Insurance Coverage

2007: Hispanics were 3 times more likely to be uninsured than non-Hispanic Whites (31% versus 10%, respectively)2007: Families with income below the poverty level were 3 times more likely to be uninsured compared to people with family income more than twice the poverty level

Access to Resources Lower income and minority communities are less likely to have access to grocery stores with a wide variety of fruits and vegetables

Transportation

38.9% of Hispanic/Latinos, 55.2% of AAs, and 29.6% of Asians live in households with one vehicle or less compared to 24.5% of WhitesLow-income minorities spend more time traveling to work and other daily destinations than do low-income Whites because they have fewer private vehicles and use public transit and car pools more frequently

Table adapted from Brennan Ramirez LK, et al., 2008

Nonelderly Health Coverage by Race/Ethnicity, 2010

62%72% 67%

55% 59%45% 42% 39%

20%15%

14%31% 23%

33%28% 29%

19% 14% 19% 15% 18% 22%30% 32%

All U.S. White Asian Two orMoreRaces

NHOPI Black AI/ AN Hispanic

Employer Medicaid or Other Public Uninsured

DATA: 2011 March Supplement, Current Population Survey. SOURCE: Kaiser Family Foundation Analyses

266.0 Million

165.7 Million

12.6 Million

4.5 Million

0.7 Million

33.7 Million

1.7 Million

47.0 Million

Life Expectancy at Age 25 for U.S. Black and White Men with Similar

Income Levels

52.950.2

45.050.2

47.441.6

0

10

20

30

40

50

60

White Men

Black Men

* 1980s income levelsSOURCE: NLMS: Lin et al 2003 and Nancy E. Adler, Health Disparities: Measurement, Mechanisms, and Meaning presentation, NIH

$25,000 or more $10,000 or less$10,000-$24,999

*

The Affordable Care Act• Designed to provide all Americans with adequate health care

• Requires health insurance to be available for all individuals and families• Employers must provide full time employees with health insurance

• http://www.healthcare.gov/law/timeline/index.html

• Faces opposition on portions of the requirements

• Many logistical issues for full enactment also remain

The Affordable Care Act• Cannot provide a solution for de facto segregation and differences in

access due to location

• Physician shortage is becoming more pronounced, especially for primary care

• Financial constraints on small businesses to provide insurance

• Actual cost v. project costs?

Date of download: 3/16/2013Copyright © 2012 American Medical Association.

All rights reserved.

From: Health Coverage Under the Affordable Care Act

JAMA. 2012;308(24):2556-2556. doi:10.1001/jama.2012.128713

Figure Legend:

Federal ACA Funding by Program Category

Employers/ Business47.3%

Workforce and Training

4.2%

Maternal and Pregnancy

4.3%

Prevention and Public Health

4.3%Medicaid and Medicare

8.2%Private Insurance and the Exchange

21.8%

Health Centers8.1%

Health Care Facilities and Clinics

1.9%

Total: $12.1 BillionSOURCE: KFF Analysis of ACA Funding, April 2, 2012.

New State and Federal Medicaid Expenditures under ACA, with All States and No States Expanding Medicaid, 2013-2022

$76 $68$8

$952

$152

$800

ACA with All StatesExpanding Medicaid

ACA with No StatesExpanding Medicaid

Incremental Impact ofMedicaid Expansion

State

Federal

Source: Urban Institute estimates prepared for the Kaiser Commission on Medicaid and the Uninsured, October 2012.

$ in billions:

Global Health Initiative• US Government sponsored program, results focused on three main areas:

protecting communities from infectious disease, saving mothers and children, and creating an AIDs free generation.

• GHI Principles:1. Focus on women, girls and gender equality

2. Encourage country ownership and invest in country-led plans

3. Build sustainability through health system strengthening

4. Strengthen and leverage key multilateral organizations, global health partnerships and private sector engagement

5. Increase impact through strategic coordination and integration

6. Promote learning and accountability through monitoring and evaluation

7. Accelerate results through research and innovation

Organizations that Provide Access to Health Care in Underserved Countries

• Doctors without Borders

• Truman Foundation

• Gates Foundation

• International Service Learning

• Many others

Research and Programs on Health Disparities

• Most of the information gathered comes from surveys.

• It focuses on the determinants of health including economical and social.

• The CDC’s National Center for Chronic Disease Prevention and Health Promotion is working to eliminate health disparities.

REACH

• Stands for Racial and Ethnic Approaches for Community Health

• It is focused at the community level to eliminate health disparities.

• Works with local chapters of national programs and funds community based organizations.

• Also gathers information from its own risk factor survey.

• http://www.cdc.gov/reach/new_reach/reach-in-action.htm