Health Disparities in the United States and the Nursing Implications for Increasing Access and Equity

Presented By: Claudette D. Powell, R.N., B.S.N., M.A. President, Caribbean American Nurses Association

Former President, Jamaica Nurses Group of New York Co-chair, Jamaican Diaspora Health Sector N.E. USA

Jamaican Diaspora Canada Foundation Health ForumJuly 10, 2014

In the United States today, many citizens are caught in a quagmire in which accessing adequate healthcare has become an extremely difficult journey; a journey for some that never ends. Many American born citizens experience some degree of hardship, poverty and chronic illnesses which preclude them from accessing the care that they need. Meanwhile there is another segment of the United States that is facing even harsher circumstances, such as the ethnic minority groups and immigrants.

Introduction

Healthy People 2020 is the federal government's prevention agenda for building a healthier nation. The vision of Healthy People 2020 is to have a society in which all people live long, healthy lives. [www.healthypeople.gov/2020]

Healthy People 2020

• The disparities/inequalities in the United States healthcare system

• Factors influencing disparities• Measures to increase access and equity• Nursing implications/innovations to facilitate access and equity

Overview

Health Disparities - 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.

-Definition by the National Institutes of Health, September 1999 in response to a White House initiative to develop a strategic plan for reducing health disparities.

Health Equity - Achieving the highest level of health for all people. Health focused societal efforts to address avoidable inequalities by equalizing the health for all groups, especially for those who have experiences disadvantage or historical injustices.

-Healthy People 2020, US Dept. of Health and Human Services

Definitions

Factors Influencing Health Disparities

• Lack of insurance coverage• Restrictive health plans• Lack of support system• Immigration status• Scarcity of health care providers• Linguistic barriers and problems with patient-provider communication• Lack of diversity in the health care work force• Age and sexual orientation• Lack of preventative care and access to expensive diagnostic tests• Structural barriers e.g. excessive time spent in waiting room

Health Disparity in Chronic Diseases

• Cardiovascular diseases: heart diseases and stroke. Leading cause of death and disability• Diabetes mellitus• Cancer• Statistical data for risk factors:

Smoking Physical activity High blood pressure Obesity Diabetes High cholesterol

Measures to Reduce Health Disparities, Increase Access and Equity

• Expand access to services for all ethnic and racial groups• Cultural competencies for health care workers• Implementation of the provisions for the Affordable Care Act• Expand insurance coverage• Train persons in medical interpretation to help serve patients with limited command of English• Family and community education• Confront social, economical, and environmental factors that contribute to health disparities• Increase primary care providers including nurse practitioners• Train community workers to help persons navigate the health care system• Expand health screening and immunization

What is Healthcare Reform?

• On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act of (ACA) 2010 (H.R. 3590), the “Senate bill” Adopted by the Senate on December 24, 2009 Adopted without amendment by the House on March 21, 2010

• On March 30, 2010, President Obama signed the Health Care and Education Reconciliation Act of 2010 (H.R. 4872), the “Reconciliation bill” Amends the Patient Protection Act

• Healthcare Reform is now the law

Major Provisions of Healthcare Reform

• Medicaid expansions • Enhanced federal funding• Establishment of the State Exchanges• In 2010:

Controls on insurance companies, Ability to keep a child on your policy until age 26 Small business tax credits for purchasing health coverage

• In 2011 community based long term care incentives

Eligibility for Children and ParentsNEW YORK

400%

200%

150%

133%

Medicaid100%

84%

Child Health Plus

Children ages 1-5

Children ages 6-18

19-20 Year Olds Living

with ParentsParents

19 & 20 Year Olds Living

on Own

Fed

eral

Po

vert

y L

evel

(F

PL

)

Pregnant Women

Infants

Family Health Plus

The Numbers

• Nearly 5 million New Yorkers are covered by public health insurance: Medicaid insures 4.5 million people Child Health Plus insures almost 400,000 children

• Over 10.5 million New Yorkers have employer-sponsored health insurance.

• 2.7 million New Yorkers are uninsured: 2.3 million are adults ages 19-64 343,000 are children

Over the next several years, as the Affordable Care Act becomes fully operative, an emergent population of Americans who have been on the outside of the health care system will now have access to care.

Access, is no way a guarantee of equity in health care. It will be critical that there are policies in place to ensure that the quality, quantity and appropriateness of care are not separated and as a result we will have achieved the goal of health care equity.

Access Implications

Nursing Implications/Innovations

• Conduct community health education, awareness, and promotion• Nurse practitioners as primary care providers• Serve as patient advocate• Increase specialty training• Case management in home health care• Telehealth monitoring-using real time data to assess and teach patients remotely• Medical missions• Legislative activity• Increase knowledge/use of technology for assessment, teaching and documentation

Pursuing equity and access to health depends on reducing avoidable gaps in health status and health services among groups with different levels of social privilege [WHO 1996]

Conclusion

References

www.cdc.gov

www.hhs.gov/news

www.cancer.gov/cancertopics/factsheet

NYSDOH and Mental Hygiene.gov

Online: nystateofhealth.ny.gov By phone: 1-855-355-5777