Minority Health: Understanding Health Disparities and Inequalities - Prof. Jeffrey Guidry, Study notes of Health sciences

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Health 236 Midterm Exam Review Dr. Jeffrey Guidry Covering Chapters 1-6 in the course textbook and class notes 30 Multiple Choice and 3 True/ False Review Chapter 4 Worksheet*  Understand the Historical Background involved with minority health o African Americans arrived in America in 1619 (slavery that lasted 244 years) o The Thirteenth Amendment: ratified in 1865, outlawed slaver in the U.S. and all territories o “Jim Crow” period: the black codes relegated racial and ethnic minorities to second-class citizenship. o Tuskegee (1932-1972)—carried out in Macon County, Alabama involved 600 black men, 399 with syphilis and 201 without disease; The U.S. Public Health Service, in trying to learn more about syphilis and justify treatment programs for blacks, withheld adequate treatment from a group of poor black men who had the disease. Researchers told the men they were being treated for “bad blood.” They did not receive the proper treatment needed to cure their illness. In exchange the men received free medical exams, free meals, and burial insurance. It was originally projected to last 6 months, but actually went on for 40 years. Summer of 1973, a class-action lawsuit filed by the National Association for the Advancement of Colored People (NAACP) ended in a settlement that gave more than $9 million to the study participants and the U.S. government promised to give free medical and burial services to all living participants. The Tuskegee Health Benefit Program was established to provide these services. It also gave health services for wives, widows, and children who had been infected because of the study. o Black people got inferior care because of their race o Civil Rights Act 1964  Prohibited discrimination in public accommodations such as mass transportation, restaurants, and hotels on the basis of race, color religion, or national origin; shifted government policy away from the support of racially discriminatory social norms o Voting Rights Act 1965  Eliminated discriminatory election practices and suspended literacy tests ans provided for the appointment of federal examiners (this and the CRA dismantled the most limiting components of the “Jim Crow Laws” and fulfilled the constitutional guarantees contained in the 14th and 15th amendments o The arrival of the European settlers in the New World led to the introduction of diseases not native to the continent as well as war o Indian Removal Act  Signed by President Andrew Jackson, ushered in a period of forcible removal of the five Civilized Tribes and their relocation (Trail of Tears) to reservations in Oklahoma territory o Organization that was in charge of providing health care to Native American Tribes (Indian Health Service) o Health Care organizations  Know the importance of studying minority health o Two demographic trends:  An aging society combined with increasing proportions of minorities that place an increasing demand on a health care system that seems ill-prepared to handle it, thus it’s important for minority health to be a central feature of training programs in public health, medicine, nursing, social work, pharmaceutical science, and other disciplines that relate to health. o Understand why health disparities exist  Group identity by appearance, culture, nationality, and so on o Provide adequate health services for all minorities o Prepare for the next generation of health professionals to work with an in minority populations o Minorities will eventually make up 50% of population…?  The definition of race and the race concept o Race: “biological term used to describe ethnic groups on the basis of physical characteristics” o Blumenbach’s classification of race: Caucasian, white; Mongolian, yellow; Malayan, brown; Negro, black; American, red  Understand the problems involved with the race concept 1. The concept has not been clearly defined nor consistently applied—races are classified differently depending on the country. 2. There is no consensus definition of race 3. Race is often confounded with other relate concepts such as ethnicity and nationality 4. The existence of races has little support from biological or genetic research o Two people with the same genetic makeup can receive a different designation depending on the society they are born o The same person can have different status depending on when they were born (before 1985 in Japan or after 1989 in the U.S.) o The terms race, ethnicity, and nationality are NOT interchangeable! o Often concepts such as ethnicity, skin color, and nationality are “captured” together in one inclusive term and this results in some degree of measurement error and leaves a great deal of room for erroneous interpretation of research findings as well as other consequences.  Major Depressive Disorder: a combination of symptoms that interfere with one’s ability to work, study, sleep, eat, and enjoy pleasurable activities  Dysthymic Disorder: long-term chronic symptoms that do not disable but keep one from functioning well or from feeling good  Bipolar Disorder: cycling mood changes that include one or more manic episodes and one or more major depressive episodes  Suicidal Disorder: organized attempts to harm or kill oneself  Psychotic Disorders  Schizophrenia: brain disorder characterized by delusions, hallucinations, disorganized speech and behavior, and so on— more prevalent in men, but they get it at the same rate but men have more severe effects and are less responsive to medication  Anxiety Disorders  Panic Disorder: panic attacks or discrete periods of intense terror or discomfort in the absence of real threat or danger  Obsessive-Compulsive Disorder (OCD): intrusive, anxious thoughts and impulses and engagement in ritualized or repetitive behaviors  Posttraumatic Stress Disorder: intense fear, hopelessness, and horror following an extreme traumatic event  Social Phobia: excessive or unreasonable fear about social or performance situations  Specific Phobias: intense and persistent fear of objects and situations that pose little or no actual danger  Generalized Anxiety Disorder: chronic, persistent, and exaggerated worry and tension that are difficult to control  Eating Disorders  Anorexia Nervosa: the restriction of food and the refusal to maintain a normal body weight  Bulimia Nervosa: recurrent episodes of binge eating, excessive eating, and purging  Childhood Disorders  Attention-Deficit/Hyperactivity Disorder: developmental disorder of self-control characterized by a pattern of inattention, hyperactivity, and impulsivity.  Autistic Disorder: developmental disorder that affects a person’s ability to communicate, form relationships, and respond appropriately to the environment  Cognitive Disorders  Alzheimer’s Disease: age-related irreversible brain disorder manifested by memory loss, decline in thinking, and personality changes  Chapter 6: o Health Care disparities: differences in quality of care that are not due to clinically appropriate treatment decisions or patient preferences— treatment, equality, and quality of care (looking at treatment, quality, and outcome) o Health Status disparities: differences among racial or ethnic groups in health status including morbidity, mortality, --differences in statistics of morbidity, mortality, disability, etc. (looking at the status of health among a group or population) o Health Care dissimilarities: issues that are not caused by underlying inequities differences are by patient cultural preferences or patient choice —natural differences that just happen because people are different and people’s cultures are different (patient preference; looks at individual)  Understand what the layman’s terms is for the definitions o Role of Institute of Medicine: 1989-2002—major research arm of federal government that looks at policy and programing regarding health care disparities o Racial and ethnic variations and access and use of health care: insurance, trust of system and mistrust, location, transportation, know where to get it and how to get it (having knowledge) o Constructs of the Behavioral Model:  Enabling factors: relate to structural or material resources that can be barriers or facilitators in seeking care. Example—having health insurance; the ability to take sick time off from work; having access to transportation; or having a preexisting relationship with a health care provider.  Predisposing factors: measure the patient’s inclination to use health services; this includes the patient’s attitudes toward using care, which are influenced by cultural beliefs, prior experiences, and perceptions  Need for healthcare: refers to the patient’s perceived need for health care services; this includes the individual’s health status and the severity and duration of their symptoms. o Population & situations relating to cultural competence: roles of health related and cultural values, disease, in most cases racial and ethnic minorities aren’t seen by providers who aren’t the same race as them