Racism: a social system, both historical and contemporary, that systematically restricts access to society's goods, including work and fair pay, safe housing, quality schools, wealth, health care, and so on, to members of socially constructed racial and ethnic minority groups through exploitation, exclusion, and policies/laws that have disparate impact.
Inclusive of everyday forms of prejudicial treatment (discrimination), cultural racism (socialization of the population to accept as true the inferiority of nondominant groups; explicit bias and implicit bias), and structural racism (the embeddedness of racism within society's laws, policies, and institutions).
** Far more expansive than poor individual treatment of one another **
Conceptual model (context) linking race/ethnicity and nativity to health and mortality
Anthropologist/MD Seth Holmes conducted a major ethnographic study of farmworker health at the Tanaka Brothers Farm (and lived and worked with them in Oaxaca, crossed the Border with them [got caught in the Arizona desert], and then lived/worked with them in Washington and California)
Fresh Fruit, Broken Bodies
Consider 4 aspects of undocumented Mexican farmworkers coming to the US to improve their lives:
1) Policy ... Bracero Program, 1965 Immigration Act, NAFTA, Border Policy, Very Weak Immigration Policy for Farmworkers, Lack of Access to Care and Legal Rights for Undocumented Workers
2) Hierarchy ... Who does the most difficult work in the US and why?
3) Narrative ... How do we talk about the immigrants and the health issues associated with immigration and work?
4) How do all of us benefit from undocumented immigration in the United States? What should we do ... as individuals, as communities, and as a society?
Adult women face higher rates of most health
conditions and age-related limitations
Cancer, Arthritis, Lung disease, Asthma, Psychological Distress, Fair/Poor Self-rated Health, Physiological Functioning Limitations, Need for Personal Care Assistance, and Need for Routine Care Assistance
Women live more years, with poorer health, than men - the Gender Paradox
Women - short-term, chronic, non-fatal
Men - life-threatening
Why?
Biological?
Genetics, Physiology, Anatomy, Hormones
Socio-structural?
Social status,
Occupational prestige, Control
Psychosocial?
Stress/Coping Mechanisms, Social Support
Behavioral?
Exercise/Diet, Substance Use, Health Care
Hyper-masculinity: the idealized form of masculinity at a given time and place; socially dominant; it subordinates feminitities as well as other forms of masculinity. Represents power and authority. Ironically, it is in the pursuit of this power and privilege that men tend to harm their own health ... E.g., unsafe driving, violence, drug use, smoking, chew, heavy alcohol use, no doctor visits, no sunscreen, don't openly acknowledge pain, etc... As well as harm the health of others (e.g., violence, subordination).
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Drawing from the slides and class presentation, if we were to rank-order groups by SES, who would be at the top
Indian (south Asian) Americans
Native Americans have some of the highest diabetes rates (15.9% of adults nationally, 24.1% in Southern Arizona). Which of the following likely contributes to this problem?
Question
All the above contribute
Life expectancy for NH Blacks/African Americans is
Getting worse over time
The Termination Act of 1953 was a highly controversial government policy. What did it do?
Stopped all federal services to Native American reservations
Which of these groups constitutes the largest percentage of immigrants to the U.S.
asians
Which of the following groups does the Whitehall finding apply to?
All of the above
Lets say we have 5 women in class - all 20 years old. Based on data presented in class and knowing that these are general trends and may not predict health for a specific person, who is likely to live the longest based on just this information?
Alicia, Asian American woman
Which of the following is the most surprising finding
That Latinos experience lower cancer mortality than non-Hispanic Whites
Evidence presented in class indicates NH Blacks are more likely to die from Septicemia, to be hospitalized for lower extremity amputation in the context of diabetes, and survive for less time at the same stage of cancer compared to NH Whites. What do all 3 of these outcomes have in common?
- all related to genetics
- all are related to discrimination
Ok, so based on all we've discussed, which group appears to have the best health among these groups?
asian americans
Does Hispanic health follow the results of Whitehall?
yes?
Which of the following IS NOT a reason for the lack of data on LGBT heath disparities?
low education in these populations
Based on the available data presented in class, which of the following has the best health outcomes including longest life expectancy?
Foreign-born Hispanics living in a low SES barrio
Which of the following is the leading reason for health disparities in LGBT communities?
Societies treatment of these groups
Over time, people are living longer for every racial/ethnic group with the exception of...
Non-Hispanic Blacks/African Americans
According to recent evidence, which of the following contributes to the "deaths of despair" phenomenon?
- drugs
- alcohol
- suicide
highest education attainment by race/ ethnicity
Asian, pacific islander= 80% graduate HS, 66% enroll in college, 50% graduate college
Indian= 76% graduate college
lowest education attainment by race/ ethnicity
NH Black= 17.8% college graduates
Hispanics= 13% college graduates
the latino mortality paradox
The epidemiological phenomenon where Hispanics/Latinos experience lower mortality relative to Non-Hispanics Whites despite disproportionately greater socioeconomic risk
Barrio effects
Mixed evidence
- some ethnically- dense neighborhoods associated with a range of benefits including
- lower risk of depression
- lower infant mortality
- lower incidence of cancers
*STRONGER AMONG LOWER SES/FOREIGN BORN
3 latino mortality paradox's
- infant mortality paradox
- adult mortality paradox
- moderation by age., background, nativity and acculturation
How do NH Blacks/African Americans compare in terms of diabetes outcomes (likelihood of hospitalization, amputations, ESRD, mortality)?
- 1.8 times more likely to have been diagnosed with diabetes
- 1.7 times more likely to be hospitalized for diabetes
- 3.5 times more likely to be hospitalized for lower extremity amputation
- 3.4 times more likely to start treatment for end stage renal disease
How do NH Blacks/African Americans compare in terms of healthcare quality and access
health care quality is low because of prior stigmatization that the race has leading to poor healthcare quality and access
How do NH Blacks/African Americans compare to NH Whites in terms of value of a dollar and accumulated wealth?
NH Blacks are the lowest on the chart with $34,598 in income
What is the relationship between SES and NH Black/White health disparities - is it related, does it partially explain, or fully explain differences
compared to whites,
blacks
- receive less income at the same levels of education
- have less wealth at equivalent income levels
- have less purchasing power (at a given level of income) because of higher costs of goods and services
What is the emerging trend referred to as the "deaths of despair"?
that a lack of steady, well-paying jobs for whites without college degrees has caused pain, distress and social dysfunction to build up over time.
How is non-hispanic white mortality in middle age (45-54) compare to racial/ethnic minorities ?
It's compared to a greater number due to amount of NH whites that are dying airing this age and it doesn't matter if they are educated or not.
what are the leading causes of death that appear to be driving this effect ?
Drugs
alcohol
suicide
Why is there a lack of data in LGBTQ+ populations
- Stigma and discrimination with reporting
- Federal health surveys do no include questions regarding sexual orientation
- Lack of appropriate questions to survey these groups
LGBTQ+ health behaviors
- lesbians are less likely to get preventive services for cancer
- lesbians and bisexual females are more likely to be overweight or obese
- transgender individuals have a high prevalence of HIV/STDS victimization, mental health issues and suicide and less likely to have health insurance
- have the highest rates of tobacco, alcohol and other drug use
LGBTQ+ assessment
•Legal discrimination
•No/little protection against bullying
•Lack of appropriate social programs
•Shortage of health care providers who are knowledgeable and culturally competent
•Higher rate of receiving poor quality of care due to stigma and insensitivity
LGBTQ+ physical barriers causing disparities
•Safe schools, neighborhoods, housing
•Access to recreational facilities
•Availability of safe meeting places
•Access the health services
individual level contemporary intervention
example given in class about being a psych major, you are able to help one person at a time
- empirically-based therapy or intervention
why culturally adapt
- to improve engagement
- to promote retention
- to increase reverence by
addressing
( specific risk and protective factors)
- to increase probability for respect
- to improve outcomes
community level interventions
- promotores de salud/community healthcare workers
- community members who function as a liaison between their community and healthcare providers
- training/ certification
- return to community to improve health
strategies for improving the physical environment for nutrition
- place limits on marketing of junk food to children ( around schools, parks)
- promote local public markets
- provide incentives for business that provide healthy food
- use zoning tools to limit the density of fast food restaurants
strategies for improving the physical environment for nutrition (cont)
- change grocery options
result: communities adapt within weeks, alters dieting patterns
- provide health information on menus (eg, add calories to menus)
Intervention at the national level
- national policy outlined in healthy people
- specific laws
- healthcare reform
( affordable care act)
- improves health care access for all
change the physical environment cont..
leading public health institutions recommend creating but environment change as evidence- based strategy to prevent obesity and associated chronic disease
cultural tailored interventions
- take an existing therapy- do a culturally translations and then use it to improve health
- cultural translation means to only adjust language but the delivery of the treatment so that it is sensitive to the values of the population
diabetes NH blacks
compare to NHW, there are significant disparities and outcomes for most racial/ethnic minorities
NH blacks disparities in heart disease
compares to NHW, NHB are significantly greater CVD risk
the termination act of 1953
•Most controversial governmental policy toward reservation life
- it reduced costs and ignored individual needs
- federal services were stopped immediately
- the effect of governmental order was disastrous
- In 1975, the government resumed the services
diabetes disparities in American Indians
total= 15.9%
by region- southern Arizona= 24.1%
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