Health 20 MC
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Lecture5.pptxIntroduction to Health Sciences
Lecture 5: Health Disparities I
Instructor: Jen-Hao Chen, Ph.D
What is “health disparity”
A disproportion number of health conditions and deaths compared with general population. For example:
What is “health disparity”
Let’s consider the following case: two men in their 60s, John and Kevin. John has diabetes but Kevin does not.
Is this case an example of “health disparity”? Why or Why not?
What is “health disparity
Let’s consider another case: one men (John) and one women (Anna) in their 60s. John was recently diagnosed with prostate cancer. Of course, Anna will never get prostate cancer.
Is this case an example of “health disparity”? Why or Why not?
What is “health disparity
When scientists talk about “health disparity”, they often refer to health differences between “groups”
Also, those health differences are NOT due to biology
A more precise definition
Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are disproportionally experienced by socially disadvantaged populations
Definition given by the U.S. Centers for Disease Control and Prevention (CDC)
A federal agency
Its main goal is to protect public health and safety through the control and prevention of disease, injury, and disability in the US
”Disproportion” means significantly higher (not due to chance)
Key features of health disparities
Health Disparities
Preventable
Can be any health condition
Disproportionally affects disadvantaged groups
How do we know health disparities exist?
By examining
Government records (i.e., death certificate)
Hospital records
Survey
How do we know health disparities exist? Death Certificate
One of the most reliable sources
Hospital record can be biased: those without health insurance do not have records
Survey can be biased too: people answer survey may not know their health conditions; individuals with poor health may not be able to answer survey questions (although these issues can be solved with careful survey design)
How do we know health disparities exist? Death Certificate
Consider the following scenarios
Long life is almost universally valued
So disparity in life means there is a huge difference in health between group
| Group 1 | Group 2 | |
| A: Getting flu | 15% | 5% |
| B: Getting cancer | 15% | 5% |
| C: Life expectancy | 65 | 55 |
So what do we know about disparity in life?
Disparity in life is calculated by life expectancy
Life expectancy (at birth): average time an individual is expected to live
Life expectancy at birth changes over time
A baby born in 1980 has a different life expectancy than a baby born in 1990
A history of life expectancy
A history of life expectancy
Although we have a great improvement in life expectancy, not all groups benefit equally……
Let’s talk a closer look
| 1990 | 2000 | Gain or loss | |
| White men | 74.6 | 76 | +1.4 |
| White women | 80.6 | 80.8 | +0.2 |
| African American men | 67.4 | 69.9 | +2.5 |
| African American women | 75.6 | 76.2 | +0.6 |
This is not the end of the story
Multiple group memberships and disparities in life expectancy
Disadvantaged status can compound…….
Racial minority + low-education
Transgender + low-income
Undocumented immigrant + low-income + low-education
Multiple group memberships and disparities in life expectancy
| 1990 | 2000 | Gain or loss | |
| White men | |||
| low education | 72 | 72.1 | +0.1 |
| high education | 78.2 | 80 | +1.8 |
| African American men | |||
| low education | 65.2 | 67.3 | +2.0 |
| high education | 72.3 | 75.6 | +3.3 |
Multiple group memberships and disparities in life expectancy
| 1990 | 2000 | Gain or loss | |
| White women | |||
| low education | 79.3 | 78.4 | -0.9 |
| high education | 82.8 | 83.8 | +1.0 |
| African American women | |||
| low education | 74.4 | 74.2 | -0.2 |
| high education | 77.9 | 79.6 | +1.7 |
So what we observe
Racial gap in life expectancy slightly declines but the gap remains
Education gap in life expectancy increases
Why?????
Explanation of the declining racial gap in life expectancy
How can we find out what contribute the decline of racial gap in life expectancy?
By looking at causes of death
If previously African Americans are disproportionally more likely to die from certain health conditions and now they are no more likely to die from those conditions, then gap in life expectancy will decrease
Explanation of the declining racial gap in life expectancy
Research shows that death rates for African Americans have been improved for the following conditions
Homicide
HIV
Unintentional injuries or accidents (ranked 3rd in the leading causes of death in the US)
Explanation of the declining racial gap in life expectancy
But racial gap in life expectancy remains because there is relatively little improvement in other health conditions
Heart disease (ranked 1st in the leading causes of death in the US)
Cancer (ranked 2nd in the leading causes of death in the US)
Stroke (ranked 4th in the leading causes of death in the US)
Alzheimer’s disease (ranked 5th in the leading causes of death in the US)
Health Disparities
A factor may be important factor for one form of health disparities may not an important factor for another form of health disparities
Very different than Biological mechanisms ! Which is almost universal
For example, discrimination may contribute to the racial disparities in health but has little influence on educational disparities in health
As such, no single policy or program can work for every group
Health Disparities by Geographic Location
Why Health Disparities Exist?
We have seen health disparities are so prevalent in the United States.
Why they exist?
