1. Community Health
and Minorities
Chapter 10

4. Introduction
• Strength of America lies in diversity of people
• Race remains an issue in U.S.
• U.S. population
• Majority – white, non-Hispanic (66%)
• Racial or ethnic minorities (34%)
• Minority health – morbidity and mortality of
ethnic minorities

5. • Define morbidity
• Mortality?

6. U.S. Population by Race/Ethnicity, 2008

7. U.S. Population Projection by
Race/Ethnicity

8. • Projections in numbers of members of each
ethnicity by 2050?

9. Introduction
• Advances in health gains are not equal in U.S.
• Secretary’s Task Force Report on Black and
Minority Health
• Initiative to Eliminate Racial and Ethnic
Disparities in Health (Race and Health
Initiative)

10. Disparity
• Compare african american
• Hispanic…define
native american

11. 6 causes of death accounts for 80% of all in
minorities
• Infant mortality
• Cancer
• CVD and stroke
• Diabetes
• Homicide and accidents
• Addictive drugs

12. Age adjusted death rates for selected causes

13. continued

14. The index of disparity
• Differences between rates of health status
indicators between minoritities and non
minorities
• 5 HSIs went up
• 17 went down

15. Disparity Index

16. Race and Health Initiative
• 1) to achieve health
• 2) eliminate disparity
• 3) improve all peoples’ health
• It is part of healthy people 2010’s goals

17. Racial and Ethnic Classifications
• Classifications used to operationalize race and
ethnicity
• Challenges with classifications representing
diversity of population
• Categories of race are more social than
biological
• Self-reported data can be unreliable
• Many nonfederal systems do not collect racial
and ethnic data

18. Races
• American indian or alaskan native
• Asian or pacific islander
• Black
• White
Ethnic groups
g)Hispanic b) non hispanic

19. Health Data Sources and Their Limitations
• Challenges in complete and accurate collection
of racial and ethnic data
• Bias analysis = numerator and denominator
issues.. Numbers not exact
• HHS has long-term strategy for improving
collection and use of racial and ethnic data
• Important to understand health beliefs of
various groups
• Heterogeneity within groups

20. 1997 expanded race definition
• 5 categories: separated asian or Pacific
islander into
• Asian and Native Hawaiian or Pacific Islander
• Also term latino or hispanic used
• And negro used as well as black or african
american

21. What is black?
• In south africa?
• In australia?

22. What is a jew?
• In canada or usa ( Lennie Kravitz)
• In germany WW2? (PARENTAGE)

23. Americans of Hispanic Origin
• Hispanic origin is an ethnicity, not a race
• Persons of Mexican, Puerto Rican, Cuban,
Central American, or South American descent,
or some other Spanish origin
• Nearly all Hispanics (96%) in the U.S. are
classified by race as white
• Educational attainment: a major disparity
• Income: a major disparity
• Health beliefs

24. Hispanics
• 2008 47 million hispanics ( 15.4% usa)
• Most rapidly growing
• Especially mexican americans
• Hispanics lowest high school achievement
levels (57% in 1980 and 75% in 2008)
• Poverty rates = 22%

25. Black Americans
• Black or African Americans
• People having origins in any of the black racial
groups from Africa ( 2008 =12.4% of USA)
• More than ½ live in southern regions of U.S.
• Educational attainment < whites> hispanics
• Income is lowest of all groups!! (24% in
poverty)
• Health beliefs and culture

26. Asian Americans and Pacific Islanders
• Now two separate racial groups
• Generally concentrated in the western states
• Educational attainment well off
• Income well off, a BIPOLAR Distribution
• Health beliefs
• Variations among the many groups
• Generational differences
• Asians 4.4% usa not “Model Community”

27. American Indians and Alaska Natives
• Original inhabitants of America
• Economically and socially disadvantaged
• Relatively poor health status
• Education: low achievment levels
• Income poverty level 25.7%
• Health beliefs
• Various tribal groups have distinct customs,
languages, and beliefs
• Many share the same cultural values

28. Native Americans and Health Care
• Many tribes are sovereign nations
• Tribes transferred land in U.S. to federal
government in return for provision of certain
services
• Indian Health Services (IHS) within HHS
• Responsible for federal health services to
Native Americans and Alaska Natives
• Goal to raise health status to highest possible
level

29. Completed High School by Race and
Hispanic Origin, U.S.

30. Real Median Income by Race and Hispanic
Origin, U.S.

31. Poverty Rates by Race and Hispanic
Origin, U.S.

32. Refugees
• Refugees
• Immigrants
• Aliens
• Illegal aliens
• Can be classified into existing racial/ethnic
groups; as a single group, present special
concerns
• Education, health problems, injuries,
employment, etc.

33. Race and Health Initiative
• Goal to eliminate disparities among racial and
ethnic minority populations in six areas of
health while maintaining progress of overall
health of American people
• Infant mortality
• Cancer screening and management
• Cardiovascular disease
• Diabetes
• HIV/AIDS
• Adult and child immunization

34. Infant Mortality ( before 1 year old)
• Serious disparity in U.S. among racial and
ethnic minorities
• Black Americans infant death rate more than
two times that of white Americans
• Lack of prenatal care and low-birth-weight
babies

36. Infant Mortality Rates by Race and
Hispanic Origin of Mother, U.S.

37. Babies of Low Birth Weight by Mother’s
Race and Hispanic Origin, U.S.

39. Cancer Screening and Management
• Incidence and death rates highest among black
Americans for various types of cancer
• Many disparities attributed to lifestyle factors,
late diagnosis, access to health care
• Less primary and secondary prevention in
various minority groups
• 550,000 cancer deaths/year
• Lung ,rectum, colon and prostate cancer

40. Examples of primary prevention?
• Hint…….lifestyle
• Examples of secondary prevention?
• Hint ……..screening tests

41. 50 to 75 year old fecal occult tests or low
endoscopy

42. Cancer Incidence and Death Rates, U.S., by
Cancer Site and Race

43. Cardiovascular Diseases ( number 1 killer)
• Death rates vary widely among racial and
ethnic groups ( coronary and stroke)
• Black Americans have higher rates from CHD
and stroke
• Hypertension prevalence as a risk factor
varies according to race/ethnicity
• Black American tend to develop hypertension
earlier in life than whites; unknown reason

44. Heart disease per 100000 2006

45. Diagnosed age adjusted prevalence of
hypertension by race

46. Strokes per 100000 2006

47. Diabetes
• Overall prevalence has risen in U.S. in recent
years
• Prevalence in those 20 and older varies in
minority groups
• Increase in age-adjusted death rates in all racial
and ethnic groups
• Significantly higher in minority groups
• American indians>black>hispanic

48. Diabetes Age-Adjusted Prevalence by
Race/Ethnicity, U.S.

49. HIV Infection/AIDS
• Proportional distribution of AIDS cases has
increased in black Americans and Hispanics
and decreased in white Americans
• Attributed to higher prevalence of unsafe or
risky health behaviors, and lack of access to
health care to provide early diagnosis and
treatment
• Since 1981, ½ all AIDS cases are in minorities

50. Percentages of AIDS by Race/Ethnicity and
Year of Diagnosis, U.S.

51. % HIV/AIDS cases by race 2007

52. Child and Adult Immunization Rates
• Early childhood immunizations do not vary
significantly by race or ethnicity
• Older adult immunization rates are
substantially lower in minority groups, even
though an overall increase has occurred

53. Socioeconomic Status and Racial and
Ethnic Disparities in Health
• Many factors contribute to health disparities –
economic, educational, behavioral, cultural,
legal, and political
• Socioeconomic status (SES) considered the
most influential single contributor to premature
morbidity and mortality
• Association between SES and race/ethnicity is
complicated and cannot fully explain all
disparity

54. Indirect causal associations
• Poverty leads to morbidity and mortality
• Circumstances explain most of morbidity
issues
• Education
• Income
• Social status

55. % adults 65 and over with pneumococcal
vaccine

56. Relationship Between Race and Health

57. Equity in Minority Health
• Simple solutions unlikely
• Solutions to problems for one group may not
work for another
• Solutions must be culturally sensitive

58. Cultural Competence
• A set of congruent behaviors, attitudes, and
policies that come together in a system,
agency, or among professionals, that enables
effective work in cross-cultural situations
• Culture is vital in how community health
professionals deliver services and how
community members respond to programs and
interventions

59. Empowering the Self and the Community
• To enable people to solve their community
health problems
• Three kinds of power associated with
empowerment
• Social – access to “bases”; needed to gain
political power
• Political – power of voice and collective action
• Psychological – individual sense of potency

61. Discussion Questions
• Why have there been so many changes to
racial and ethnic classifications in the United
States in recent decades?
• How can community health programs
empower minority groups?