Healthcare disparities and models for change.

With Healthy People 2010 making the goal of eliminating health disparities a national priority, policymakers, researchers, medical centers, managed care organizations (MCOs), and advocacy organizations have been called on to move beyond the historic documentation of health disparities and proceed with an agenda to translate policy recommendations into practice. Working models that have successfully reduced health disparities in managed care settings were presented at the National Managed Health Care Congress Inaugural Forum on Reducing Racial and Ethnic Disparities in Health Care on March 10-11, 2003, in Washington, DC. These models are being used by federal, state, and municipal governments, as well as private, commercial, and Medicaid MCOs. Successful models and programs at all levels reduce health disparities by forming partnerships based on common goals to provide care, to educate, and to rebuild healthcare systems. Municipal models work in collaboration with state and federal agencies to integrate patient care with technology. Several basic elements of MCOs help to reduce disparities through emphasis on preventive care, community and member health education, case management and disease management tracking, centralized data collection, and use of sophisticated technology to analyze data and coordinate services. At the community level, there are leveraged funds from the Health Resources and Services Administration's Bureau of Primary Health Care. Well-designed models provide seamless monitoring of patient care and outcomes by integrating human and information system resources

Assessing Health Concerns and Barriers in a Heterogeneous Latino Community

Introduction. Major health issues and barriers to health services for Latino immigrants were identified through community-based participatory research in Baltimore city. Methods. In collaboration with community partners, five focus groups were conducted among Latino adults from 10 countries and health service providers. Findings. Priorities across groups included chronic diseases, HIV/AIDS and STDs, mental health, and the need for ancillary services. Community members and providers did not always agree on what health matters were of primary concern. Participants expected to receive health information at the point of service. Barriers to receiving health services and information span linguistic, financial, logistical, legal, and cultural matters. Conclusions. This formative research illustrates the complexity and interrelatedness of health priorities and barriers created by social issues such as employment, legal status, and related stressors

Overweight status of the primary caregivers of orphan and vulnerable children in 3 Southern African countries: a cross sectional study

Background: Africa is facing a nutritional transition where underweight and overweight coexist. Although the majority of programs for orphan and vulnerable children (OVC) focus on undernourishment, the association between OVC primary caregiving and the caregivers\u27 overweight status remains unclear. We investigated the association between OVC primary caregiving status with women\u27s overweight status in Namibia, Swaziland and Zambia. Methods: Demographic Health Survey (DHS) cross-sectional data collected during 2006-2007 were analyzed using weighted marginal means and logistic regressions. We analyzed data from 20-49 year old women in Namibia (N 6638), Swaziland (N 2875), and Zambia (N 4497.) Results: The overweight prevalence of the primary caregivers of OVC ranged from 27.0 % (Namibia) to 61.3 % (Swaziland). In Namibia, OVC primary caregivers were just as likely or even less likely to be overweight than other primary caregivers. In Swaziland and Zambia, OVC primary caregivers were just as likely or more likely to be overweight than other primary caregivers. In Swaziland and Zambia, OVC primary caregivers were more likely to be overweight than non-primary caregivers living with OVC (Swaziland AOR = 1.56, Zambia AOR = 2.62) and non-primary caregivers not living with OVC (Swaziland AOR = 1.92, Zambia AOR = 1.94). Namibian OVC caregivers were less likely to be overweight than non-caregivers not living with an OVC only in certain age groups (21-29 and 41-49 years old). Conclusions: African public health systems/OVC programs may face an overweight epidemic alongside existing HIV/AIDS, tuberculosis and malaria epidemics. Future studies/interventions to curb overweight should consider OVC caregiving status and address country-level differences

Strategies to increase happiness and wellbeing among public health students, faculty and staff

BACKGROUND: Public health schools equip students with skills to promote and protect health, however, little is known about what is provided to support physical, mental and social wellbeing in academic public health. AIMS: To identify programs, interventions, strategies, and tools in medical and academic settings that could be applicable to supporting mental health and wellbeing of public health professionals, students, staff and faculty. METHOD: In November 2019 (updated in January 2022), 13 databases were searched: PubMed, 10 EBSCO databases(e.g., Academic Search Ultimate, APA PsycINFO, CINAHL Plus, Education Source, ERIC, Health Source: Nursing/Academic Edition, MEDLINE, SocINDEX), ProQuest Dissertations & Theses Global, and Web of Science. Inclusion criteria were randomized controlled trials, group interventions to support mental health curriculum, online tools, strategies, techniques, and programs of mindfulness, anxiety, depression, stress/distress, or burnout. Studies were limited to English and from 1998 to January 3, 2022. Websites for U.S. Schools of Public Health were searched. RESULTS: Out of 19,527 articles, 6,752 duplicates were removed. Following abstract and title screening, full-text articles will be screened for eligibility. The main themes from included studies will be shared. Preliminary findings show examples of activities to support well-being of public health professional students, staff, and faculty (e.g., providing free access to meditation apps, funding a dedicated wellness coordinator within the School). CONCLUSIONS: The literature on strategies to increase happiness and wellbeing among public health students, faculty, and staff is scarce and efforts to support physical mental, and social wellbeing for this community should be evaluated, and findings shared

Providing linguistically appropriate services to persons with limited English proficiency: a needs and resources investigation.

Increasing numbers of persons in the United States cannot speak, read, write, or understand the English language at a level that permits them to interact effectively. These limitations can hamper encounters between patients and healthcare providers, often leading to misunderstandings as to diagnosis and treatment, which in turn may result in poor patient compliance, unsatisfactory outcomes, and increased costs. A questionnaire was developed and distributed to clinical practice managers at the University of Maryland School of Medicine to assess the needs for language interpretation services and resources among clinical faculty providing healthcare to persons with limited English proficiency (LEP). Literature review, search of key Web sites, and consultation with national experts on issues pertaining to language access, health services, and reimbursement strategies also were done. Then, recommendations regarding the costs and benefits of language interpretation in healthcare settings were developed. Because recipients of federal financial assistance from the Department of Health and Human Services must provide meaningful access to persons with LEP at no cost to the client, there are clear benefits to providing language interpretation. Providers and managers should be made aware of interpretation service options and cost-saving strategies

Epidemiology, Policy, and Racial/Ethnic Minority Health Disparities

http://dx.doi.org/10.1016/j.annepidem.2012.04.01

Emergency Preparedness: Knowledge and Perceptions of Latin American Immigrants

This paper describes the level of public emergency knowledge and perceptions of risks among Latin American immigrants, and their preferred and actual sources of emergency preparedness information (including warning signals). Five Latino community member focus groups, and one focus group of community health workers, were conducted in a suburban county of Washington D.C. (N51). Participants came from 13 Latin American countries, and 64.7% immigrated during the previous five years. Participants had difficulty defining emergency and reported a wide range of perceived personal emergency risks: immigration problems; crime, personal insecurity, gangs; home/traffic accidents; home fires; environmental problems; and snipers. As in previous studies, few participants had received information on emergency preparedness, and most did not have an emergency plan. Findings regarding key messages and motivating factors can be used to develop clear, prioritized messages for communication regarding emergencies and emergency preparedness for Latin American immigrant communities in the U.S

Variations in Healthcare Access and Utilization Among Mexican Immigrants: The Role of Documentation Status

The objective of this study is to identify differences in healthcare access and utilization among Mexican immigrants by documentation status. Cross-sectional survey data are analyzed to identify differences in healthcare access and utilization across Mexican immigrant categories. Multivariable logistic regression and the Blinder-Oaxaca decomposition are used to parse out differences into observed and unobserved components. Mexican immigrants ages 18 and above who are immigrants of California households and responded to the 2007 California Health Interview Survey (2,600 documented and 1,038 undocumented immigrants). Undocumented immigrants from Mexico are 27% less likely to have a doctor visit in the previous year and 35% less likely to have a usual source of care compared to documented Mexican immigrants after controlling for confounding variables. Approximately 88% of these disparities can be attributed to predisposing, enabling and need determinants in our model. The remaining disparities are attributed to unobserved heterogeneity. This study shows that undocumented immigrants from Mexico are much less likely to have a physician visit in the previous year and a usual source of care compared to documented immigrants from Mexico. The recently approved Patient Protection and Affordable Care Act will not reduce these disparities unless undocumented immigrants are granted some form of legal status

Methodological issues in measuring health disparities

OBJECTIVES: This report discusses six issues that affect the measurement of disparities in health between groups in a population: Selecting a reference point from which to measure disparity. Measuring disparity in absolute or in relative terms. Measuring in terms of favorable or adverse events. Measuring in pair-wise or in summary fashion. Choosing whether to weight groups according to group size. Deciding whether to consider any inherent ordering of the groups. These issues represent choices that are made when disparities are measured. METHODS: Examples are used to highlight how these choices affect specific measures of disparity. RESULTS: These choices can affect the size and direction of disparities measured at a point in time and conclusions about the size and direction of changes in disparity over time. Eleven guidelines for measuring disparities are presented. CONCLUSIONS: Choices concerning the measurement of disparity should be made deliberately, recognizing that each choice will affect the results. When results are presented, the choices on which the measurements are based should be described clearly and justified appropriately.By Kenneth Keppel, Elsie Pamuk, John Lynch, Olivia Carter-Pokras, Insun Kim, Vickie Mays, Jeffrey Pearcy, Victor Schoenbach, and Joel S. Weissma