racial and ethnic health disparities

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RACIAL AND ETHNIC HEALTH DISPARITIES

and the HHS Office for Civil Rights

U.S. Department of Health & Human Services

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Overview

• What are health disparities?

• What is the role of discrimination in health disparities?

• What can the HHS Office for Civil Rights do to reduce health disparities?

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What are “Racial and Ethnic Health Disparities”?

• Differences in rates of diseases• Differences in health outcomes

affecting the health status of certain racial or

ethnic groups

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Differences in rates of disease

Blacks and American Indians have diabetes at higher

rates than Whites

EXAMPLES of Health Disparities

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EXAMPLESof Health Disparities

Differences in outcomes of disease

Compared to Whites, a higher percentage of Black and Native American babies

die in the first year of life

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Differences in outcomes of disease

Black women die of cervical

cancer at twice the rate of White women

EXAMPLESof Health Disparities

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What are “Racial and Ethnic Health Disparities”?

Differences in health care access

and medical treatment

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Differences in access/treatment

In one study -- Minority nursing home patients were less

likely than White patients to receive

medicine for their pain

EXAMPLES

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Differences in access/treatment

Racial minorities are less likely than Whites to

receive certain cardiac diagnostic

procedures

EXAMPLES

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HHS: Addressing Health Disparities

GOALS:• Increase Quality and Years of Healthy Life• Eliminate Health Disparities

www.healthypeople.gov

OCR webpage links to over 20 HHS health disparities initiatives:

http://www.hhs.gov/ocr/healthdisparities.html

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HHS Secretary’s 500-Day PlanCommitment To Transforming

Health Care

In the next 500 days, Secretary Mike Leavitt will concentrate on, in the area of health disparities:

“Supporting community-based approaches to closing the healthcare gap, particularly among racial and ethnic minority populations, including American Indians and Alaska Natives.”

http://www.hhs.gov/500DayPlan/500dayplan.html

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HHS Initiatives to Address Health Disparities

• Closing the Health Gap Initiative and “Take A Loved One to the Doctor” Day

• National Center on Minority Health and Health Disparities (NIH)

• HHS Health Disparities Council• Other HHS health disparities centers

and grant programs at NCI, AHRQ, HRSA, CMS

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HHS Promising PracticesPartnerships with community and faith-

based organizations and with universities, e.g.:

• U. Pitt. Center for Minority Health• Medical University of South Carolina• Laguna Pueblo Community Health

Representatives• Latin American Cancer Research Coalition• People’s Health Center• Vietnamese Reach for Health Initiative

Coalition

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OCR’s Role

HHS-OCR’s responsibility:to enforce Title VI of the Civil Rights Act of 1964 --

as it applies to health care providers who receive federal funds or other

assistance from HHS

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• Tuskegee experiment

• Segregation of medical facilities and health care

providers

LEGACY: DISTRUST AND RELUCTANCE TO SEEK CARE

A Short History of Discrimination in Health Care

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Protects persons of every race, color or national origin from unlawful discrimination

– Race: e.g., Black, White, Asian– Color: skin color, regardless of race– National Origin: ancestry or

ethnicity, can include language proficiency

Title VI of the Civil Rights Act of 1964

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Unlawful Discrimination Title VI

Recipients of Federal financial assistance may not on the basis of race, color, or national origin:

• deny an individual a service, aid, or other benefit

• provide a benefit which is different or provided in a different manner

• subject an individual to segregation or separate treatment

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• Under Title VI, HHS recipients may not:– restrict an individual in the

enjoyment of benefits, privileges– treat an individual differently in

determining eligibility – deny a person an opportunity to participate on a planning or advisory board

Unlawful Discrimination (continued)

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Recipients include:• Hospitals, nursing homes, home

health agencies, managed care organizations

• Health research programs• Physicians, dentists, hospital social

workers, • Other providers who receive Federal

financial assistance from HHS

Who is Covered by Title VI?

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What causesdifferences in

health status?

Discrimination vs. Other Factors Contributing to

Disparities

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Occupation

insufficient education

Heredity

Lifestyle choices

Geographic barriers

Environment

Low income

Reluctance to seek treatment

Inadequate insurance

DISCRIMINATIONDISCRIMINATION

Generally, these are not unlawful discrimination under the enforcement jurisdiction

of OCR

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OCR’sResponsibility:

• Excluding a person, denying them benefits, or otherwise discriminating against them because of their race or some other prohibited reason

DISCRIMINATIONDISCRIMINATION

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May be

• Intentional, or

• Unintentional

DISCRIMINATION

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• Are there neutral reasons for the disparity? e.g., this group of patients doesn’t go to the

doctor because they lack transportation or child care?

or• Did the medical provider treat this

group of patients differently because of their race, color, or ethnicity?

Identifying Discrimination

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• Blacks wait longer to seek medical attention

• Blacks less likely than Whites to receive certain procedures and treatments

Red Flags for Discrimination

Excluding a person, denying them benefits, or otherwise discriminating

against them because of their race, color, or national

origin

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FACT:

In one study, doctors rated Black patients as less intelligent, less educated, more likely to abuse drugs and alcohol, less apt to comply with medical advice, and more likely to lack social support…

… even after their income, education, and personality characteristics were taken into account.

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Discrimination?

• Beliefs or attitudes alone are not discriminatory.

• BUT IF beliefs can be shown to affect the way people are treated, the treatment may be discriminatory.

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FACT:

Among Medicare recipients in managed care health plans, Blacks were less likely to receive:

• Breast cancer screenings• Eye exams when diabetic• Medicine after a heart attack• Follow-up after hospitalization

for mental illness• Flu shots

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Discrimination?

Doctors/HMOs seem to be treating patients differently on the basis of race …

… more investigation would be needed.

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• Asthmatic African-Americans in one health maintenance organization (“HMO”) were less likely than Whites to see specialists and to use inhalers, and were more likely to be hospitalized

• Blacks with diabetes are less likely to get proper medical care than White diabetics

Discrimination?

Possibly.

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What To Do If….

• You believe you or someone else has been discriminated against by a health care provider…..

• You are a health care provider and want help in improving access to your services by racial and ethnic minorities….

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Contact OCR

We can help!

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What Can OCR Do?

• Complaint Investigations• Compliance Reviews • Voluntary Compliance• Technical Assistance

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• Provide information on racial and ethnic health disparities to recipients and other providers upon request

• Refer recipients to quality resources• Review recipient policies and make

suggestions • Make presentations to organizations

What Else Can OCR Do? Technical Assistance

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FOR MORE INFORMATIONFOR MORE INFORMATION

policy guidance fact sheets complaint forms regional office contact

information

Available on OCR’s website:

www.hhs.gov/ocr