differences in health outcomes between groups
Select agencies within the National Institutes of Health also support what are called Centers for Population Health and Health Disparities (CPHHDs). Investigate healthcare disparities in your state (if you are currently living overseas, use the last state you lived in). (2008), who studied differences in cancer coverage in newspapers targeted to Black audiences and newspapers meant for a general audience. The likelihood of meeting the Sustainable Development Goal 3 on good health and well-being is closely linked to the targets of goal 11 on sustainable cities and communities. In doing so, communication researchers must keep communication theory in mind and focus on those etiological factors that would respond to a communication intervention. The objective of the study is to examine the presence, direction, and magnitude of possible differences between proxy-reported and patient-reported outcomes in health and … Health21: An Introduction to the Health for All Policy Framework for the WHO European Region. A meta-analysis of 155 studies that looked at the prevalence of dental caries found that lower socioeconomic status, as indicated by levels of education, occupation, or income, was associated with higher risk of having lesions or experience with dental caries; the relationship appeared to be stronger in more developed countries (Schwendicke et al., 2015). Among the general health information seekers, respondents who did not use the Internet had less awareness of the HPV vaccine, were less likely to know that HPV causes cervical cancer, and were less likely to know that HPV was sexually transmitted; among cancer information seekers, however, no differences emerged between those who used the Internet and those who did not. Braveman (2014) emphasizes this point in her discussion of health disparities and health equity, noting that in this context, health disparities are not merely differences in health status; rather, they are differences stemming from inequity: Health equity and health disparities are intertwined. Health inequities are systematic differences in health outcomes. A health disparity/inequality is a particular type of difference in health or in the most important influences on health that could potentially be shaped by policies; it is a difference in which disadvantaged social groups (such as the poor, racial/ethnic minorities, women, or other groups that have persistently experienced social disadvantage or discrimination) systematically experience worse … According to its vision statement, “NIMHD envisions an America in which all populations will have an equal opportunity to live long, healthy and productive lives,” and its mission is “to lead scientific research to improve minority health and reduce health disparities” (NIMDH, n.d.). There are also differences in outcomes relating to socioeconomic status, ethnicity, geographical area and other social factors. This explosion of interest, however, should be considered with more history in mind. A study investigating socioeconomic inequalities in health in 22 European countries found that mortality rates were higher and self-assessments of health were lower for groups with lower socioeconomic status (Mackenbach et al., 2008). 8–9). The term ‘health inequities’ relates to perceived unfair differences in health outcomes between groups that are potentially avoidable. In the extensive literature on socioeconomic health disparities, less attention has been paid to examining the variability in health outcomes within social or economic groups. Proxy responses are very common when surveys are conducted among the elderly or disabled population. In short, more and better research is needed if we are to advance our knowledge and build a cumulative science of health disparities. A meta-analysis of 35 studies involving women in Australia, Canada, New Zealand, and the United States found that although there were no differences in risk of cervical dysplasia or carcinoma in situ between indigenous and nonindigenous populations, indigenous women had a “markedly higher” risk of invasive cervical cancer and related mortality (Vasilevska, Ross, Gesink, & Fisman, 2012); this finding parallels results from studies of women from lower and higher socioeconomic status in the United States, which find that poor women are more likely to be diagnosed with cervical cancer at later stages, thus putting them at greater risk for mortality. Although a review of these theoretical models is beyond the scope of this entry, it is important to note that communication researchers should pay particular attention to those that highlight factors most amenable to communication interventions. Examples include reductions in cardiovascular disease and cancer in disadvantaged groups in England and reductions in maternal and child deaths in Ecuador. The National Institutes of Health includes the National Institute on Minority Health and Health Disparities (NIMHD), which was elevated from Institute to Center status in 2010. When autocomplete results are available use up and down arrows to review and enter to select. The Health Information National Trends Survey (HINTS) conducted by the National Cancer Institute’s Division of Cancer Control and Population Sciences surveys a nationally representative sample of Americans to assess how they seek information about cancer. CDC Health Disparities and Inequalities Report—United States, 2011. These are covered in the report, but we’ve placed a special focus on inequalities between ethnic groups and see major differences in health behaviours and outcomes between them. Oxford Research Encyclopedia of Communication, College of Communication and Information, University of Kentucky, U.S. Department of Health and Human Services, CDC: Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, National Institute on Minority Health and Health Disparities, Office of Minority Health & Health Equity, Rockefeller Foundation and the Swedish International Development Cooperation Agency, U. S. Department of Health and Human Services, Gender (Gay, Lesbian, Bisexual and Transgender Studies), Incidence and Prevalence of Morbidity and Mortality, Health Literacy and Health Information Seeking, https://doi.org/10.1093/acrefore/9780190228613.013.222, http://www.tandfonline.com/action/journalInformation?show=aimsScope&journalCode=ceth20, http://digitalscholarship.unlv.edu/jhdrp/, http://www.springer.com/medicine/journal/40615, http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review, http://www.euro.who.int/__data/assets/pdf_file/0004/109759/EHFA5-E.pdf, http://www.ahrq.gov/professionals/education/curriculum-tools/population-health/adler.html, Health disparities and health equity: Concepts and measurement, Specifying race-ethnic differences in risk for psychiatric disorders in a US national sample, A systematic review and meta-analysis of the effectiveness of behavioural smoking cessation interventions in selected disadvantaged groups, Racial and ethnic approaches to community health: Reducing health disparities by addressing social determinants of health, http://www.cdc.gov/nccdphp/dch/programs/reach/pdf/final_reach_fact-sheet-092012_tag508.pdf, Cancer coverage in general-audience and Black newspapers, The promise of prevention: The effects of four preventable risk factors on national life expectancy and life expectancy disparities by race and county in the United States, Migration, social mobility and common mental disorders: Critical review of the literature and meta-analysis, Racial/ethnic disparities in HIV infection among people who inject drugs: An international systematic review and meta-analysis, Conceptual approaches to the study of health disparities, Race and ethnicity in public health research: Models to explain health disparities, Do interventions designed to support shared decision-making reduce health inequalities? Foster transdisciplinary collaborations that integrate evidence from basic biomedical science with social, behavioral, and population science methodologies in intervention design and outcomes assessment. ‘Health inequalities’ refers to differences in health outcomes between groups, for example a higher rate of lung cancer incidence in more deprived areas compared with less deprived areas. In shifting to aspects of mental health, a meta-analysis of 12 studies that considered migration, social mobility, and mental health found that migrants who experienced “downward social mobility” were more likely to experience mental disorders than those who either had no change in their socioeconomic status or experienced an increase in socioeconomic status (Das-Munshi, Leavey, Stansfeld, & Prince, 2012). Physical determinants implicate the built environment, which can either facilitate or impede health promotion, and environmental hazards, such as poor air or water quality. Inequalities exist across a range of dimensions, such as socio-economic deprivation and personal characteristics like age and sex. It is of interest to note that the term “health disparities” is most commonly used in the United States, whereas other countries tend to use the terms “health inequities” or “health inequalities” (Carter-Pokras & Baquet, 2002). differences in health outcomes by groups, for instance, between males and females, people of different ethnicities, and people of lower and higher socioeconomic status. They are 14 times more likely to die before the age of five in sub-Saharan Africa than the rest of the world. A definition from Braveman (2006) highlights the role of policy and social advantage in potentially ameliorating health disparities: A health disparity/inequality is a particular type of difference in health or in the most important influences on health that could potentially be shaped by policies; it is a difference in which disadvantaged social groups (such as the poor, racial/ethnic minorities, women, or other groups that have persistently experienced social disadvantage or discrimination) systematically experience worse health or greater health risks than more advantaged groups. Design and evaluate rigorous multilevel interventions to change both individual behavior and the social, policy, and built environments; assess multidirectional influences of interventions. Nursing and Health Science. This arises from loses in productivity and tax payments, and from higher welfare payments and health care costs. Buckner-Brown et al. There are multiple definitions of health disparities available. To control for these unobserved variables, the DD estimate of the reform’s effect subtracts the second difference from the first. Methodological advances in identifying, defining, and measuring health disparities are needed to enhance the quality of our research. Two studies that focused on non-small cell lung cancer provide clear examples. Health disparities are similarities in health outcomes between groups. These health inequalities, avoidable and unfair differences in health status between groups of people or communities1, reflect historic and present-day social inequalities in our population. Mortality. In low-resource settings, health-care costs for noncommunicable diseases (NCDs) can quickly drain household resources, driving families into poverty. In terms of policy, requiring seatbelt use, restricting smoking areas, and increasing tax on alcoholic beverages all can have a positive impact on health. Expand efforts to dismantle historical and contemporary drivers of stigmatization and discrimination of persons who are members of disparate populations. Pre-reform differences in outcomes are perhaps due to unobserved differences across states that contaminated the previous, naive estimate. (State- and local-level agencies have similar charges, but a review of these is beyond the scope of this essay.) (Cooper et al., 2015, p. S375). Black or African American refers to people having origins in any of the black racial groups of Africa, including those of Caribbean identity. Another is the point of comparison or the reference group used in a study. The remaining DD could be plausibly attributed to the reform. Their objectives are “to develop and test multilevel interventions to reduce health disparities, to use community-based participatory research (CBPR) principles, to train a new generation of transdisciplinary researchers in collaborative team science, and to promote translation and broad dissemination of evidence-based strategies into practice and policy” (Cooper et al., 2015, p. S374). A literature search of five major databases (MEDLINE, PsycINFO, CINAHL, Psychology and Behavioral Sciences Collection, Academic Search Complete) using “health disparities” as a subject term revealed 19 academic journal articles published between 1965 and 2000, 214 published between 2001 and 2005, 5,828 between 2006 and 2010, and 13,800 between 2010 and 2015. One is the basis on which groups are being compared. The journal also publishes review articles, short communications, letters to the editor, and notes from the field.” (http://link.springer.com/journal/10903), Journal of Racial and Ethnic Health Disparities: “Journal of Racial and Ethnic Health Disparities aims to report on the scholarly progress of work to understand, address, and ultimately eliminate health disparities based on race and ethnicity. When da… For example, in the United States of America, African Americans represent only about 13% of the population but account for almost half of all new HIV infections. Harvard social epidemiologist Nancy Krieger (2001) wrote a letter to the editor of the International Journal of Epidemiology noting how toward the end of the 20th century, researchers were publishing papers that reported “seemingly new observations” regarding the relationship between socioeconomic status and health status. have different levels of health, yet not all of these differences are always categorized or defined as health disparities. Although this is a very cursory review of the literature using only the macro subject term “health disparities” in five databases, the point remains the same: In recent years, academic interest in health disparities has exploded. Populations of interest tend to be defined primarily by socioeconomic status (income/education), race, ethnicity, and sex or gender; however, differences in sexual orientation, immigrant status, geography, and physical and mental disability are also of concern. Parsing the respondents into “general health information seekers” and “cancer information seekers” revealed interesting subtleties. The following sections address each of these fronts. Efforts to reduce health disparities are extensive and involve government and foundation efforts and research-driven interventions. Health inequities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age. There is no biological or genetic reason for these alarming differences in health. Although these particular meta-analyses suggest that disadvantaged groups may suffer from worse mental health, it should be noted that on the whole Hispanics and non-Hispanic Blacks have a lower risk for mental illness than non-Hispanic Whites (Breslau et al., 2006; Mezuk et al., 2013), although their access to mental health care may be worse (McGuire & Miranda, 2008). These inequities have significant social and economic costs both to individuals and societies. A systematic review and meta-analysis, http://www.health.harvard.edu/newsletter_article/mars-vs-venus-the-gender-gap-in-health, http://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health, Temporal trends and racial/ethnic disparity in self-reported pediatric food allergy in the United States, Translating research evidence into practice to reduce health disparities: A social determinants approach, Contribution of communication inequalities to disparities in human papillomavirus vaccine awareness and knowledge, Psychological morbidity and quality of life of ethnic minority patients with cancer: A systematic review and meta-analysis, The relationship between health literacy and health disparities: A systematic review, “White Box” epidemiology and the social neuroscience of health behaviors: The Environmental affordances model, Recruitment and retention for community-based eHealth interventions with populations of low socioeconomic position: Strategies and challenges, Female gender is an independent prognostic factor in non-small-cell lung cancer: A meta-analysis, Effect of culturally tailored diabetes education in ethnic minorities with type 2 diabetes, Communication about health disparities in the mass media, http://www.cdc.gov/minorityhealth/OMHHE.html, Introduction: Communication and health care disparities, http://www.rwjf.org/en/library/annual-reports/presidents-message-2014.html, http://www.equinetafrica.org/sites/default/files/uploads/documents/ROCequity.pdf, Rethinking the vulnerability of minority populations in research, Socioeconomic inequality and caries: A systematic review and meta-analysis, Socioeconomic differences in lung cancer incidence: A systematic review and meta-analysis, http://www.health.gov/communication/literacy/, Socioeconomic disadvantage and disease-specific mortality in Asia: Systematic review with meta-analysis of population-based cohort studies, Health disparities, communication inequalities, and ehealth, Cancer information disparities between U.S.- and foreign-born populations, The ACT2 Program and Eliminating Racial and Ethnic Disparities in HIV and AIDS Clinical Trials: A Case Study in Health and Risk Messaging, Neighborhood Considerations for Social Determinants of Health and Risk, Culture, a Social Determinant of Health and Risk: Considerations for Health and Risk Messaging, Statistical Evidence in Health and Risk Messaging, Government-Driven Incentives to Improve Health, Public Health and Community Organizing as Agents for Change in Health and Risk Messaging, Ethical Issues and Considerations in Health and Risk Message Design, Communications Research in Using Genomics for Health Promotion. Mortality is an essential population health outcome measure. Health disparities are the metric we use to measure progress toward achieving health equity. If these risk factors were reduced to their “optimal levels,” life expectancy would increase on the whole by approximately 4.9 years in men and 4.1 years in women. The -suest- command in Stata was used to assess significant differences in the associations between inadequate access to care and health outcomes across age groups in men and women and by sex in the age groups. Adler (2006) notes how different countries tend to use different categories to distinguish between advantaged and disadvantaged groups. They found that respondents who did not use the Internet had less awareness of the HPV vaccine and were less likely to know that HPV causes cervical cancer. Below is a sample of meta-analytic studies of interventions designed to reduce a variety of health disparities. Moreover, when adapting to the multi-cultural contexts of the … They offered seven recommendations, quoted here: Reframe the discussion about health disparities and inequities. The authors’ main conclusions, though, focused on the methodological limitations of the studies, which led to inconsistent findings. All racial and ethnic groups experienced improvements in health coverage, access, and utilization compared to prior to the ACA (Figure 1). Health literacy is defined as “the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (USDHHS, 2012). The causal effects of policies and programs related to vaccines, vehicle safety, toxic substances, pollution, legal and illegal drugs, and health behaviors are difficult to measure. This fact file looks at what health inequities are, provides examples and shows their cost to society. One of its newest initiatives, Building a Culture of Health, is designed to promote and establish a culture change in the United States that makes health a priority for all (RWJF, 2014). Central to all of these definitions is the idea that health disparities stem from disadvantage and, as such, they are unnecessary and avoidable and, therefore, unjust and unfair (Whitehead, 1992). Outcomes reported by proxy may be systematically different from those obtained from patients directly. This report investigates health disparities in the United Kingdom related to socioeconomic status, ethnic status, and sex; it also makes recommendations to address the social determinants of health underlying the disparities. These health inequalities, differences in health between people or groups of people that may be considered unfair, reflect historic and present-day social inequalities in our population. She offered the following caution to anyone concerned with alleviating health disparities: We do a disservice to the weight of evidence, past and present, on social inequalities in health if we suggest that what chiefly hampers efforts to promote social equity in health is a lack of knowledge, whether of the social patterning of health, or trends, or pathways. Prioritize community engagement and equitably shared community and researcher power to maximize intervention success and sustainability. This report reviews the “Health for All” policy adopted by member states of the World Health Organization’s European Region at the 51st World Health Assembly in May 1998. People with low health literacy may not understand information they receive from their health care providers or from media sources, so the question of whether or not health literacy is related to health disparities is of interest. It seems to have taken until the turn of the century before academic health researchers began paying serious attention to issues of health disparities. First, though, it is important to ask whether such efforts have any chance at improving health disparities. The inverse relationship between deprivation and health outcomes though well established as shown above (Table 2 and recently in Newton JN et al 2015) is also slightly more complex as shown below. A meta-analysis of 64 studies of lung cancer incidence found that risk for the disease increased among people with lower socioeconomic status as evidenced by three different indicators: low education, low occupation status, and low income (Sidorchuk et al., 2009). The greatest gains would be seen among Southern rural Blacks (6.7 years for men and 5.7 years for women). The Office for National Statistics analyses deaths that could be averted or delayed through timely, effective health care (‘amenable mortality’) or wider public health interventions (‘preventable mortality’). The important point is that socially advantaged and disadvantaged groups have different levels of access and exposure to and experience with these determinants of health, and that is what leads to health disparities. -two groups, one outcome, at two time points* Hotelling's T^2-measuring more than 1 dependent variable-difference between two mean vectors ... size effect-a quantitative measure of the strength of a phenomenon-a significance test does not tell the size of a difference between two measures (practical significance) ... How should the results of statistical analysis be considered in the context of health … Although some biological or genetic disparities are (currently) unavoidable, such as differences due to aging or prevalence of certain diseases among certain groups (e.g., sickle cell anemia among Blacks), disadvantage can engender biological/genetic disparities that otherwise could have been avoided, such as mental retardation among lower income children exposed to lead in municipal water and cancers resulting from exposure to environmental toxins. As described in previous chapters, there are differences in health outcomes for men and women, for different age groups and for different countries. The authors drew several important conclusions from their review. Highest blood sugar levels were apparent in Western Native American men and younger women and older Southern rural Black women. Moving toward greater equity is achieved by selectively improving the health of those who are economically/socially disadvantaged, not by a worsening of the health of those in advantaged groups. In terms of sex differences, women tend to fare better than men. These inequities arise from inequalities within and between societies. Durand et al. Interventions that enhanced access to mammography services had the largest effect; tailored interventions had a larger effect than non-tailored interventions; ethnically matched interventions and culturally matched intervention materials also had positive effects. Income was the biggest predictor of differences in health outcomes, according to Zimmerman. A meta-analysis of 35 studies of chronic kidney disease found that low socioeconomic status was associated with four indicators of kidney disease: low glomerular filtration rate (eGFR), high albuminuria, low eGFR/high albuminuria, and renal failure; results held regardless of the measure of socioeconomic status used (Vart, Gansevoort, Joosten, Bültmann, & Beijneveld, 2015). Future research and practice in health disparities is ripe with opportunity. These models can be categorized into socioenvironmental, psychosocial/behavioral, and biogenetic/physiological (LaVeist, 2005; see also Diez Roux, 2012 and Dressler, Oths, & Gravlee, 2005). They found that most studies that investigated the relationship between health literacy and health disparities focused on racial/ethnic disparities. The Centers for Disease Control and Prevention house an Office of Minority Health & Health Equity (OMHHE). Close to 1 billion people in the world live in slum conditions, representing about one quarter of the world's urban population. The U.S. Department of Health and Human Services (USDHHS, 2008), in its Healthy People 2020 initiative, provides a more comprehensive definition: A health disparity is a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Moving beyond an exclusive focus on the United States, Fleischer, Diez Roux, and Hubbard (2012) considered body mass index and smoking behavior across 70 countries using data from the 2002–2003 World Health Surveys, looking for instances of disparities by urbanicity and education. Differences in rates of avoidable mortality between population groups reflect differences in people getting the help that they need to address life-threatening health risks and illnesses. There are several important points to keep in mind when considering differences in morbidity and mortality. Every year the National Cancer Institute collects and publishes data based on patient demographics. Use a social determinants of health framework for health disparities interventions and a “health for all policies” approach to policy interventions targeting socioeconomic advantage. Acculturation. Two studies provide examples of the kinds of analyses possible. Harrington (2013) also highlighted the importance of the work of communication scholars in these efforts: Communication scholars have a clear role to play in many of the efforts to reduce health disparities. The authors emphasized the importance of partnerships with governments, businesses, and organizations to help disseminate research-based interventions. Health disparities are differences in health outcomes between socially disadvantaged and advantaged groups. ... or ‘Asian’ may mask considerable within-group differences and emphasise between-group differences. Health equity means social justice in health (i.e., no one is denied the possibility to be healthy for belonging to a group that has historically been economically/socially disadvantaged). Currently, there are 10 of these centers in the United States. Health inequalities arise because of the conditions in which we are born, grow, live, work and age. Contracting the disease makes it even harder for these adults to improve their personal economic condition and that of their families. Smoking rates were highest among younger poor White men in Appalachia and the Mississippi Valley, older Western Native American and high-risk urban Black men, and Western Native American women. This essay provides a brief review of the voluminous literature on health disparities, with a focus on several major threads including populations of interest, incidence and prevalence of morbidity and mortality, determinants of health, health literacy and health information seeking, media influences on health disparities, and efforts to reduce disparities. Providing a brief highlight of the literature, Harrington (2013) showed the answer is yes: Koh et al. In the United States, there are federal agencies tasked with the goal of reducing health disparities. This should include differences and health outcomes between groups. This section reviews a sample of meta-analytic studies that explore different aspects of disparities in morbidity and mortality. Among women, most cases of cervical cancer can be prevented by the right mix of government policies the! Between the groups on the whole, results showed that Whites had highest... 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That explain the etiology of health of central interest to communication researchers, interventionists, and many groups... By them to death Americans ” ( RWJF, n.d. ) their majority counterparts the rest the!
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