MI-LEND Video Resource: Equity and Social Determinants of Health (Week 4)

Summary

This video presentation explores the crucial topic of equity and social determinants of health, focusing on individuals with intellectual and developmental disabilities. It highlights the complexities of disability in America, emphasizing how social, environmental, and systemic factors influence health outcomes. Discussions extend to include federal policies, health disparities, and the pivotal role of culturally competent care. Through data analysis, thought-provoking analogies, and interactive questions, the session encourages questioning how societal structures can be shifted to promote equity and better health outcomes.

Highlights

• The presentation focuses on social determinants of health for people with developmental disabilities. 🎓
• Interactive questions challenge participants to think about equity and health outcomes. 🤔
• The video stresses the role of societal structures in creating health disparities. 🏗️
• Federal policies often overlook disabilities in medically underserved populations. 📜
• The presentation underlines the importance of culturally competent healthcare. 🏥

Key Takeaways

• Equity in health requires understanding social determinants of health, especially for those with disabilities. 🌍
• Addressing health disparities involves improving cultural competence among healthcare providers. 💡
• Socioeconomic factors, not just genetics, are crucial in determining health outcomes. 💪
• Social reforms have been key to improving life expectancy, challenging the emphasis solely on medical advancements. 🚀
• Culturally competent communication can bridge gaps in healthcare for diverse populations. 🌐

Overview

The presentation kicks off by highlighting how equity and social determinants play into the health framework, specifically for individuals with intellectual and developmental disabilities. The speaker emphasizes the necessity of coming together to eradicate barriers and advocating for equitable healthcare access. The use of a vivid analogy reveals how societal structures often place unnecessary limitations, and demands a shift in perspective to view disability through an equity lens.

A deep dive into statistics reveals stark disparities faced by disabled communities, segmented further by race and ethnicity. Discussions delve into the pressing need for more competent care providers, armed with cultural sensitivity and understanding. The talk invites healthcare providers to broaden their view, examining their patient demographics to include marginalized groups who might be falling through the cracks due to systemic inadequacies.

Interactive elements engage the audience, challenging their preconceived notions about healthcare and its connection to social determinants. Throughout the presentation, the speaker advocates for proactive actions—asking pertinent questions, addressing policy gaps, and embracing a comprehensive view of health beyond mere medical care. Drawing on resources like the National Core Indicators enhances understanding and encourages actionable change towards equity.

Chapters

• 00:00 - 00:30: Introduction to Equity and Social Determinants of Health The chapter discusses equity and social determinants of health, emphasizing its significance and personal relevance to the speaker. It notes that the discussion will focus on understanding these issues in the context of working with patients.
• 00:30 - 01:30: Focus on Intellectual and Developmental Disabilities The chapter discusses intellectual and developmental disabilities, focusing on engaging individuals and their families in the discourse. The approach is interactive, with the speaker intending to pause for questions and to pose questions to the audience. The aim is to foster engagement and ensure an interactive experience. The text mentions the mland project's four core considerations, summarized by the acronym LIFE, which stands for Leadership, indicating a focus on leadership as a key element in the discourse on intellectual and developmental disabilities.
• 01:30 - 02:30: Importance of Social Determinants The chapter focuses on the importance of social determinants of health and their relation to equity in healthcare. It emphasizes interdisciplinary, family-centered care, aiming to integrate equity into healthcare practices. Future workshops and training sessions will continue to explore related concepts, with a concentrated focus in today's session on understanding and addressing social determinants of health.
• 02:30 - 03:30: Data on Disabilities in America This chapter delves into the crucial social determinants affecting the health and well-being of families and children in Michigan dealing with developmental disabilities or autism spectrum disorder (ASD). It explores environmental and social barriers impacting health outcomes and the accessibility of care and services for individuals with ASD or developmental disabilities. Through this discussion, it aims to shine a light on key issues and identify barriers to improved health access and equity.
• 03:30 - 04:30: Healthcare Utilization by People with Disabilities The chapter explores strategies to address health disparities faced by individuals with disabilities. It emphasizes the importance of considering equity and social determinants of health when serving this population. While the focus is on individuals with intellectual and developmental disabilities, the underlying principles could be applied to various situations and groups. The chapter begins by examining a broad view of disability.
• 04:30 - 05:30: Affordable Care Act and Disability The chapter provides insights into the population of individuals with disabilities in the United States, highlighting key statistics from the US Census. It states that over 54 million people in the US live with a disability, and 35 million of these individuals have severe disabilities, requiring assistance with functional activities or have mental, emotional, or social conditions affecting their daily life. This underscores the significance of the disabled population as a substantial and vital demographic in America.
• 05:30 - 06:30: Concept of Cultural Competence The chapter titled 'Concept of Cultural Competence' discusses the importance of applying an equity lens to the health care needs of people with disabilities. It highlights a report indicating that individuals with disabilities in the United States have poorer health outcomes and utilize health care services more frequently than those without disabilities. This underlines the necessity of addressing these disparities to ensure equitable health care access and outcomes for people with disabilities. The chapter also references a recent webinar focused on policy issues related to the Affordable Care Act and people with disabilities.
• 06:30 - 07:30: Disability and Environmental Barriers The chapter titled 'Disability and Environmental Barriers' focuses on the importance of integrating disability and cultural competency into service provision. The transcript highlights a provision within an act, specifically noting clause 12, which emphasizes increasing the disability and cultural competency of providers. The discussion underscores the relevance of making equity a central pillar within the MIL (unspecified) program, illustrating the commitment to these principles.
• 07:30 - 08:30: Exploring Health Inequities In this chapter, the focus is on 'Exploring Health Inequities'. The discussion covers the Affordable Care Act's efforts to address and reduce health inequities. It highlights key components such as prohibiting discrimination, engaging with disability organizations for feedback, using Resource Centers, and collecting state-level data to monitor progress. The chapter emphasizes the importance of providing services aimed at reducing mental and physical disabilities and achieving cultural competence in healthcare.
• 08:30 - 09:30: Link between Income and Health This chapter discusses the link between income and health, focusing on the importance of considering equity and social determinants of health. It challenges traditional views of disability, arguing that disability should be seen not as a personal attribute or impairment but as a situational factor that is influenced by broader social and economic contexts. The chapter emphasizes the need for culturally competent healthcare providers to incorporate these considerations into their practice to address health disparities effectively.
• 09:30 - 10:30: Social Determinants of Health Overview This chapter discusses the social determinants of health, focusing on the interaction between individuals and their environment. The importance of reducing environmental barriers to improve people's abilities and participation is emphasized. Disability is presented as a relative concept influenced by external factors.
• 10:30 - 11:30: Health Disparities in Michigan The chapter titled 'Health Disparities in Michigan' discusses the disadvantages faced by people with disabilities, emphasizing that these challenges are not due to individual characteristics. Instead, they are a result of societal limitations and external barriers imposed by the environment.
• 11:30 - 12:30: Race and Health Inequities The chapter discusses the concept of disability as being a result of societal organization. It highlights the importance of understanding context in equity work. Equity is emphasized as a crucial lens for analyzing and addressing race and health inequities.
• 12:30 - 13:30: Social Determinants and Health of Children This chapter discusses the importance of applying an equity lens to work concerning autism spectrum disorder (ASD) and intellectual developmental disabilities (IDD), especially in children. It emphasizes the necessity of considering the broader context in which work is conducted, encouraging practitioners to question assumptions and recognize that they don’t need to have all the answers upfront. Such an approach helps tailor interventions and services to be more effective in addressing the unique needs of different populations.
• 13:30 - 14:30: Disparities in Michigan by Race and Income The chapter discusses the importance of asking the right questions to provide optimal care, and introduces a series of quiz questions to engage the audience and prompt discussion.
• 14:30 - 15:30: Cliff Analogy for Social Determinants In the chapter titled 'Cliff Analogy for Social Determinants,' the transcript starts with a mention of PLL, which seems to refer to some prior learning or previous lesson. The speaker discusses American life expectancy in comparison to other countries and prompts the audience to assess this comparison by analyzing the given information. Following this, there is a mention of a second question directed at identifying average conditions, although the transcript cuts off before specifying the conditions in detail. The analogy likely connects these questions to broader social determinants influencing life expectancy and health conditions.
• 15:30 - 16:30: Understanding Health Disparities The chapter titled "Understanding Health Disparities" discusses critical factors affecting health outcomes and disparities among different socioeconomic groups. It highlights the significant impact of socioeconomic status on health, with a specific emphasis on how children living in poverty are disproportionately affected compared to those from high-income households. The chapter also touches upon historical public health advancements, questioning the primary factors behind the notable increase in life expectancy in the U.S. during the 20th century.
• 16:30 - 17:30: Healthcare Disparities Report The chapter titled 'Healthcare Disparities Report' introduces a discussion based on questions derived from the PBS documentary 'Unnatural Causes: Is Inequality Making Us Sick?' released in 2009. This documentary series, which comprises seven parts, addresses the intricate issue of racial and socioeconomic disparities in health. Each episode has a duration of thirty minutes, with the exception of the first. This report aims to highlight and share the critical insights presented in the series regarding health inequalities influenced by racial and economic factors.
• 17:30 - 18:30: Barriers in Healthcare Process The chapter titled 'Barriers in Healthcare Process' discusses the concept of social determinants of health. The discussion is rooted in borrowed Health Equity questions and is supplemented by a brief clip that provides an explanation of social determinants of health. The text implies a perspective of humans as biological entities, influenced by our genes and other factors.
• 18:30 - 19:30: Cultural Competency in Healthcare This chapter delves into the concept of cultural competency in healthcare, emphasizing that biology is not a static determinant of who we are. It argues that our biological makeup is shaped by our life experiences and interactions with the world around us. It highlights the ongoing development throughout our lives and how our history is reflected in our bodies.
• 19:30 - 20:30: Health Disparities in Disability Community The chapter titled 'Health Disparities in Disability Community' discusses various health disparities faced by individuals with disabilities. It explores the systemic issues and barriers that contribute to unequal health outcomes in this community. The chapter highlights the importance of addressing these disparities through policy changes, increased awareness, and better access to healthcare services. Although the transcript provided is incomplete, the chapter likely emphasizes the need for inclusive healthcare practices and the impact of societal factors on the health of individuals with disabilities.
• 20:30 - 21:30: Impact of Race and Ethnicity on Disabilities The chapter highlights the health disparities faced by different racial and ethnic groups in America despite the country's high expenditure on medical care. It suggests that factors such as race and ethnicity significantly influence the experience and management of disabilities, potentially due to systemic inequalities within the healthcare system. There is an underlying critique of how resources are distributed and accessed across different communities.
• 21:30 - 22:30: Resources for Measuring Performance This chapter discusses the expenditure on health resources, highlighting that nearly half of all health dollars are spent worldwide, yet outcomes are poor. It provides statistics showing that life expectancy is lower and sickness more prevalent in some industrialized nations compared to others, with certain countries ranking very low in life expectancy, particularly among economically developed nations.
• 22:30 - 23:30: Social Determinants and Quality of Life Disparities The chapter discusses the contrast between infant mortality rates in the United States and countries like Cuba, Slovenia, and Estonia, raising questions about the underlying reasons for these disparities. The discussion points out that 47 million Americans without health insurance might contribute to the issue; however, it emphasizes that the absence of health care is not the direct cause of illnesses and diseases, much like how aspirin addresses fever symptoms without being the cause of the fever itself.
• 23:30 - 24:30: Equity Lens in Program Development This chapter explores the concept of using an equity lens in program development, primarily focused on health outcomes. It highlights the debate on whether lack of specific medications, like aspirin, or broader lifestyle factors, such as personal health behaviors determined by economic status, are more influential in health conditions like fever. The discussion emphasizes the role of income, education, and other social determinants of health in shaping these behaviors and ultimately affecting health outcomes.
• 24:30 - 25:30: Culturally Competent Communication In the chapter titled 'Culturally Competent Communication', the discussion focuses on the impact of social determinants of health, even among genetically identical individuals such as twins. Despite sharing the same genetic makeup and growing up in the same environment until the age of 18, identical twins can experience divergent health outcomes in adulthood if they encounter different social and economic environments later in life. This illustrates that our bodies are profoundly influenced by a lifetime of social experiences, which can shape health disparities. The chapter underscores the importance of considering social factors in health beyond genetic predispositions.
• 25:30 - 26:30: Policy Impacts on Disability Care The chapter discusses the impact of societal policies and conditions on disability care, emphasizing how they can influence health outcomes. The text highlights that certain societal structures contribute negatively to health and suggests that restructuring these could improve health conditions, particularly noting the significant inequalities present.
• 26:30 - 27:30: Equality vs Equity This chapter discusses the concepts of equality and equity, exploring their differences and implications on society. It highlights issues such as the unequal distribution of resources, like pet food and water, and connects these disparities to the broader problem of poor health outcomes in the United States, even among wealthier demographics. The content suggests that inequality may contribute to health issues, questioning if these conditions are avoidable. The discussion is linked to a broader inquiry into whether inequality is impacting health, with a reference to a PBS program from 2008 titled 'Unnatural Causes: Is Inequality Making Us Sick?'
• 27:30 - 28:30: Conclusion and Audience Q&A In the 'Conclusion and Audience Q&A' chapter, the audience engaged in a question related to American life expectancy. A poll was conducted revealing the participants' estimations: 41% believed the answer was option B, while 59% selected option C. However, the correct ranking of the United States in terms of life expectancy is 29th.

MI-LEND Video Resource: Equity and Social Determinants of Health (Week 4) Transcription

• 00:00 - 00:30 uh so tonight we'll be talking about um equity and social determinance of health and this is a topic that's near and dear to my heart but this is also an interesting perspective to take on this work because now we're going to be thinking about these issues in the context of our work with um p patients
• 00:30 - 01:00 with intellectual and developmental disabilities and their families so I will be uh stopping at different points during the presentation to invite you to ask questions and you'll also see there will be points at which I will be asking you a few questions as well just to try to make sure this is uh as interactive um as possible so um as you know the mland project has four core considerations using the acronym life they are lead leadership
• 01:00 - 01:30 interdisciplinary family centered care and equity and today we're going to be focusing on the equity component and a key aspect of equity is looking at Social determinants of health so that's what we'll be focusing on tonight but in some of our upcoming workshops and even throughout the rest of your training our goal is to interv uh some related Concepts so in today's session I would like to make sure that I help you
• 01:30 - 02:00 identify key social determinants that impact the health and well-being of families and children in Michigan who have developmental disabilities or are dealing with autism spectrum disorder we're also going to explore how environmental and social barriers might impact Health outcomes and the ability of persons with ASD or developmental disabilities to access care and services and then I hope to highlight a few
• 02:00 - 02:30 strategies that might help you address disparities in health when you are serving this population now the issue of equity and social determinance of health is really a lens that can be applied to many situations and populations and though we are focusing on uh people with intellectual and developmental disabilities tonight I thought it would be good for us to start by taking a snapshot look at DIS ility
• 02:30 - 03:00 in America in general um I found some data from uh the US Census that tells us that over 54 million people in the United States have a disability and 35 million have what we would characterize as a severe disability which means they need help performing functional activities or they have other mental emotional or social conditions that affect their everyday life so this shows us that people with disability are a large and important
• 03:00 - 03:30 group of Health consumers in the United States and according to a recent report people with disabilities have poor health and use Health Care at a significantly higher rate than do people without disabilities so this really emphasizes the importance of us applying the equity lens to this population now I know you just finished participating in a a webinar focused more on some policy issues around the Affordable Care Act and um people with disabilities
• 03:30 - 04:00 and so I thought it would be interesting just to take a moment to reflect upon some of the key considerations in that act and if you notice 12 which I have highlighted here um really says that we should as part of that act increase the disability and cultural competency of providers and I think that is why the designers of the mil program thought it very important to make Equity one of the key pillars of this work
• 04:00 - 04:30 in addition as we know the Affordable Care Act uh speaks to things like avoiding uh prohibiting discrimination seeking input from disability organizations engaging Resource Centers collecting state level data so we can see how we're doing and making sure that we're providing services that reduce mental and physical disability so when we um talk about being culturally competent and trying to meet that uh objective that we viewed in
• 04:30 - 05:00 the last slide we know that a core approach to being culturally competent providers is that we consider issues of equity and social determinance of health and it's very interesting when we think about the concept of disability in context because when we do that we can realize that Disability should not really be considered as a personal attribute or even a limit to impairment but really it's a situation that can
• 05:00 - 05:30 arise from the interaction between the person and his or her environment this is very important because if we're trying to reduce situations of disability and really maximize people's ability that's going to require that we reduce any of the external and environmental barriers that are preventing people from fully participating on an equal basis with others so considering that then we can really view disability as a relative con
• 05:30 - 06:00 cont uh concept and then thinking further along those lines if we want to think about the disadvantageous experiences or positions that people with disabilities might have in in our society we can rationalize that maybe it's not really because of their individual characteristics but more so it's a reflection on the limitations that our environment and external barriers are imposing on them
• 06:00 - 06:30 and as such disability might really be thought of as a result of how Society is organized and as we continue our discussion today you'll see why that concept really really is important because when I'm doing this Equity work this is a quote I really like us to like to include that for me context is the key and from that comes the understanding of everything and I mentioned Equity as being a lens that we
• 06:30 - 07:00 could apply to various populations or topics and so as we apply the equity lens to our work with the uh autism spectrum disorder and intellectual developmental disability population thinking about the context in which we do that work is going to become very key as we think about context often we have to challenge ourselves to ask questions uh we don't have to always feel like we have have all the answers
• 07:00 - 07:30 but it's very important to ask the right questions so that we can make sure we're providing the best care possible so in that spirit I have a few quiz questions that I'm going to ask you as we start uh this presentation and as we continue you'll see the answers for those and it might even spark some discussion so uh Mike I'm going to now go to the first question and I would like you to pull uh to put down your answer into your answer and then we will
• 07:30 - 08:00 PLL and see uh how we did as I give the correct answers so the first question is how does American life expectancy compare to other countries I'd like you to take a look at that and then enter your answer okay the second question is on average which of the following conditions is the
• 08:00 - 08:30 strongest predictor of your health next question children living in poverty are how many times more likely to have poor health compared with children living in high income households and final question the most important factor behind the 30-year increase in us life expectancy during the 20th century was which of these
• 08:30 - 09:00 option now these questions uh came from a website unnatural causes is inequality making us sick and this is a PBS documentary that was uh launched in 2009 to deal with the issue of racial and socioeconomic inequalities in health it's a seven-part documentary series and it's made up of several episodes each is a half hour except for the first one and I really want to share this as a
• 09:00 - 09:30 resource if you're interested in learning more about this topic but we borrowed those Health Equity questions and I also would like to show a brief clip that will um help explain a little more about the concept of social determinants of Health there's one view of us as biological creatures that we are determined by our gen
• 09:30 - 10:00 means that what we see in our biology is somehow innately us because of who we were born to be what that misses is that we grow up and develop we grow up as children we grow up as adults and continue we interact constantly with the world in which we are engaged that's the way in which our biology actually happens we carry our history and our bodies how
• 10:00 - 10:30 else could how could we [Music] [Music] not [Music]
• 10:30 - 11:00 [Music] Living in America should be a ticket to Good Health we have the highest gross national product in the world I'm very happy to finally have some of my cars in one location some of them we spend $2 trillion per year on medical care that's
• 11:00 - 11:30 nearly half of all the health dollars spent in the [Music] world but we've seen our statistics we live shorter often sicker lives than in any other industrialized country we rank 30th in life expectancy especially of economically developed countries we are at the bottom of the list a higher percentage of our
• 11:30 - 12:00 babies die in their first year of life than in Cuba Slovenia Estonia how can this [Music] be is this just because 47 million of us have no health insurance Health Care can deal with the uh diseases and illnesses but lack of Health Care is not the um cause of illness and disease it is like saying since um aspirin cures a fever that the
• 12:00 - 12:30 lack of aspirin must be the cause of the fever or is it mostly because of our American diet and personal health behaviors those behaviors themselves in part determined by economic status and so our ability to avoid smoking and eat a healthy diet depends in turn on our access to income education and what we call the Social determinance of Health
• 12:30 - 13:00 but wouldn't our genes Trump social determinants of Health among twins who lived together until age 18 who basically grew up in the same households so had at least a relatively similar exposure if they diverged later in life if one became professional and the other was working class they ended up with different health status as adults this is among identical twins written into our body is a lifetime of experience shaped by social
• 13:00 - 13:30 conditions and policies that can determine who will be sicker who will die sooner there are ways in which our society is organized that are bad for our health uh and there's no doubt that we could reconfigure ourselves in ways that would benefit our health there are huge inequalities in the society up all this wealth is
• 13:30 - 14:00 maldistributed Pet Food ice for the pets water and I think that's in part why the US is a whole has relatively poor health amongst the rich countries and why even the better off people are suffering and we think that that is not [Music] inevitable unnatural causes is inequality making us sick coming to PBS 2008 so if we now look at the questions that
• 14:00 - 14:30 we pulled on the first question asked how does American life expectancy compared to other countries and Mike can you show us what our poll revealed yes 41% chose B 59% chose C and the correct answer is 29th
• 14:30 - 15:00 Place see um we are tied with South Korea and Denmark for a life expectancy of uh 77.9 years despite being the wealthiest country on the planet so when we think about the emphasis that our society places on
• 15:00 - 15:30 Health Care it really does not fully take into account the extent to which our social circumstances contribute to our health as this figure shows adapted from mcginness 60% of our health is actually determined by our social circumstances environment and behavior and only 10% is really determined by the health care that we provide
• 15:30 - 16:00 another way to look at it is that we know a lot of attention is placed on health insurance as being directly related to health outcomes but if we apply our Equity lens to that and look more broadly we're reminded that there are many additional factors that contribute to health outcomes Beyond biological and genetic factors we know there are care process factors Health Care System characteristics Environmental factors the way people
• 16:00 - 16:30 utilize health care and demographic attributes just to name a few in addition to Social and family support so one way to think about this when I used the analogy of an equity lens is that much like when we use a microscope and we're able to adjust the level at which we choose to focus on a sample we can adjust the level at which we choose to focus on our patients or clients often we will rest right in the
• 16:30 - 17:00 individual area looking at the personal circumstances of that person their age and sex and constitutional factors but when we think about the concepts of social determinance of Health it's really important to take a step back and cast a broader lens that challenges us to think about the social and Community networks in which that individual is operating and also things like their educ ucational and work environment their
• 17:00 - 17:30 living conditions whether or not they are employed basic needs such as water and sanitation and housing so in general we're thinking about their socioeconomic cultural and environmental conditions when we talk about social determinants of Health another way to look at it is social determinants of Health are conditions in which we are born grow live work and age or another way to say it's where we live work and play and we
• 17:30 - 18:00 know that these circumstances are shaped by how power money and resources are distributed and in cases where those resources are not necessarily distributed in the most Equitable way we may find that we have health inequities which are the unfair and avoidable differences that we might see in health status within and between various populations to give you an example of how this can play out I have this slide
• 18:00 - 18:30 that's from the commission um on health that looks at racial and ethnic differences in health based on income you'll see that on the Y AIS we have the percent of people who report poor or Fair health so of course a lower number here would indicate Better Health on the x axis we have the percent above the federal poverty level that people are
• 18:30 - 19:00 living in so here having a higher percent means you have a higher income what we notice is that as income increases or as we move further along this axis the percent of people reporting poor health decreases and that that's not very surprising to us as the trailer indicated wealth Health often equals wealth and vice versa however what's interesting is that if we we also look at how race and ethnicity
• 19:00 - 19:30 influences this we see that within each income category whites have a better level of Health than any of the other racial ethnic groups so we see that increasing income results in fewer numbers with poor health but even within a category being Black Or Hispanic is going to be associated it with having poorer
• 19:30 - 20:00 Health income matters and Race Matters the second quiz question asked on average which of the following conditions is the strongest predictor of your health and Mike can you share with us how the group pulled sherff 41% chose option D whether or not you have health insurance and we see that our
• 20:00 - 20:30 answer is really based on how wealthy you are whether or not you are wealthy genes diet and exercise and other behaviors are important but for example a poor smoker still stands a greater chance of getting ill than a rich smoker our question number three asked children living in poverty are how many times more likely to have poor health compare it with children living in high
• 20:30 - 21:00 income households and Mike our results showed 47% chose option D seven times and that was the correct answer children are most vulnerable they not only when they're susceptible to substandard housing poor food bad schools unsafe streets and chronic stress but we also know that the impacts of childhood poverty are accumulative ative leading to a pile up
• 21:00 - 21:30 of risks that can influence adult health and can even affect the Next Generation now I have included a resource holes in the Mitten which is from our Michigan Department of Health and Human Services you may know that our governor general Jen Jennifer granholm in 2007 signed Public Act 653 06 into law and this statute was
• 21:30 - 22:00 designed to address the increased rates of morbidity and mortality that we were observing a minority population this law mandated that the Michigan Department of Community Health as it was then called address racial and ethnic disparities that were facing minority populations by developing and implementing an effective Statewide strategic plan this is one of the products out of the work of the office of minority Health which highlights some of the
• 22:00 - 22:30 disparities that we see by raised ethnicity and income across the state of Michigan helps us understand what some of the contributing factors might be and gives us examples of some potential interventions to close the gap you will find this on your Blackboard uh Resource page as well using the data that they collected um in this office I want to share with you a few statistics that give us an
• 22:30 - 23:00 overview or a snapshot of Health disparities within the state of Michigan and these stats are coming from the health disparities reduction and minority health section using US Census Data and the American Community uh survey so you see that across Michigan uh we do we are a state with majority white population uh but within that category we also have Arab Americans at
• 23:00 - 23:30 the rate of 1.6% our next largest um racial group is African-Americans and you can see that the third largest is Latino Hispanic ethnicity when we look at um this population in the state by those categories we start to see some very interesting patterns and I want to stop here to mention that when we talk about race and ethnicity we know that race in
• 23:30 - 24:00 particular is a social construct that has great historical implications and really is not based on significant genetic or biological differences however given the history of our nation and our state and our society over time that social construct and the Privileges and advantages that were offered that were placed upon those social categories has resulted in some very real
• 24:00 - 24:30 differences in quality of life and health outcome so we're now going to look at that a little more closely so you can understand uh what I am saying so for example if we were to look at the percent of the population living below the federal poverty level across the state it would be 15% living below that federal poverty level however if we stratify it by race and ethnicity we see
• 24:30 - 25:00 that 32.7% of African-Americans are living below the federal poverty level compared to 11% of whites we also see higher levels 29% of Arab Americans um and 24% of American Indian Alaskan natives so you get very interesting results when you break down aggregate dat data into groups by race ethnicity and other social
• 25:00 - 25:30 categories and I apologize it looks like the headings dropped off of this when I formatted it so I will just read those to you um as we go through this slide uh describes for us the percentage of the population with more than 25 percentage of the population more than 25 years old that has less than a high school diploma you see across the state 11.6% of the population more than age 25
• 25:30 - 26:00 has less than a high school diploma but if we break this down by race or ethnicity it's striking to notice that our Hispanic Latino Community has a 33% rate of less than a high school diploma the next slide is depicting the percent of households with no vehicle available for use and we know that transportation is very key to accessing other resources across the state is a 7.5% rate of households that have no
• 26:00 - 26:30 vehicle available for use when we break that down by race and ethnicity we again see large numbers of African-Americans 19.1% and American Indian Alaskan natives 12.2% with no vehicle in their hous hole available for use and that becomes particularly important when we consider what the quality and accessibility of
• 26:30 - 27:00 public transportation is for those communities the next slide depicts the percent living in a different house than they were last year this kind of serves as a proxy for housing stability across the state it's 14.8% but we see that there's a much uh higher rate for our African-Americans Asians and Latinos as compared to our
• 27:00 - 27:30 white population now of course we know there could be many reasons that someone is living in a different house than last year but I think it still begs the question why we would see such big differences the next slide refers to self-reported health status is fair or poor you'll recall I showed you that same information at the national level and now we're able to see this at a state level it's interesting to note that across the
• 27:30 - 28:00 state 15 almost over 14% of our population says their health status is fair or poor and that itself is concerning breaking it up by race and ethnicity we see that 27% of American Indian Alaskan natives describe their health as being fair or poor so we can see there is something going on when we look at these issues of race and income and health and I would like to share with
• 28:00 - 28:30 you an analogy that was developed by Dr Kamara Jones called the cliff analogy for social determinance of Health often as health care and social service providers we practice tertiary prevention we treat people once they are diagnosed and try to improve their condition or rehab them or cure them and when we're doing that we're really operating here at the bottom where we
• 28:30 - 29:00 see the ambulance we're catching people after they have fallen off the clip and we're trying to fix them up and help them be better I think most people would agree ideally we would intervene much earlier but all too often our safety net programs intervene here at the blue net that's there to catch people when they fall and that's a form of secondary prevention people already have the problem and we're trying to reduce the
• 29:00 - 29:30 impact of it primary prevention is something that we really strive for when we're trying to um prevent the problem from developing and that's where we see the gate here or the fence here keeping people from falling off of the cliff but what we might want to think about is what might we do to move people further back from the edge of the cliff
• 29:30 - 30:00 and that's really looking Upstream at Social determinance of Health again thinking about where people live work and play and how that might make them less likely to get to the edge of the cliff and have to receive our services so in thinking about social determinance of Health that way and bringing it back to our world uh of disability we can start to realize that
• 30:00 - 30:30 disability only becomes a tragedy when Society fails to provide the things that are needed to lead one's daily life and that moves us into thinking a little bit about what is our role in helping people lead their daily lives and lead and live to their their most capability and that is what health care
• 30:30 - 31:00 disparities focuses on because we know that we can take a snapshot for any given community at any given time and see that there are differences in the quality of life or health that they're experiencing the data I just reviewed showed us that and many people will say well I can't fix the world I can't cure these social injustices that we see what do you want me to do and that's why I think it's very interesting to take a moment to focus on
• 31:00 - 31:30 disparities in health care and I use Health Care here but we could use that for any of the disciplines or professions in which we practice the question is why might we see disparities in the quality of Health that we're health of care that we're delivering within medicine there was a report called unequal treatment that was commissioned by Congress in the early 2000s to look look at quality outcomes and see if there were differences and
• 31:30 - 32:00 what they found is that there were notable differences in the quality of care that was provided in terms of treatments that were offered and treatments that were not offered and they realized that these were happening due to multiple factors some of these have to do with the circumstances in which our patients or clients live things like whether or not they trust the system or whether or
• 32:00 - 32:30 not they adhere to our recommendations or their personal or cultural beliefs that might put them at increased risk also there are Health System fact uh factors or broader institutional factors for example the Health Care system can be very complex and difficult to navigate and then we can multiply that when we think about people that may have limited English proficiency or low
• 32:30 - 33:00 levels of literacy in addition however to the patient level factors and the health system factors they identified a third area which we call care process factors and this relates to what we as providers and professionals might contribute to the equation this has to do with things like unconscious bias and stereotyping in our decision making or communicating in a way that is not sensitive to the unique needs of a diverse
• 33:00 - 33:30 population so in effect this report really was very important in starting the conversation around the fact that there are racial and ethnic disparities in health care and that it's multifactorial and if we want to address them we need to do it at multiple levels we have made Improvement but there still is work to be done and the national healthc care quity and disparities report is something that's done annually
• 33:30 - 34:00 to take a retrospective look at the previous year and give us a grade as if you will as a National Health Care system on how good of a job we're doing in providing quality care across racial ethnic language income level groups the report shows that access to health care has improved dramatically largely due to the reductions in number of Americans that do not have health insurance and
• 34:00 - 34:30 increase in the number of Americans that have a usual source of medical care but and we know that quality of Health Care in general continues to improve as we have advances in medical technology and science but still we're seeing some wide variation in how effective our treatments are how well we're doing in coordinating care whether or not practicing person centered care and how Affordable Care is this is
• 34:30 - 35:00 another resource I invite you to take a look at it's available online and you can look at any number of quality indicators to get an idea of how we're doing as a large health so I've been using the terms Health disparity and healthc Care disparity and if if you recall when I mentioned Health disparity I'm referring to differences in health outcome or status and that can be considered basically a snapshot of how
• 35:00 - 35:30 we're doing on one particular indicator when I talk about health care disparity though I'm giving us a grade as providers and Health Care Professionals and it's looking at the differences in the preventive Diagnostic and treatment services that are offered to people with similar health conditions and it's important to make this distinction because Healthcare disparities do not occur in a vacuum but
• 35:30 - 36:00 are rather influenced by all of those differences we talked about in Social determinance of Health and Social resources so we cannot think that as healthc Care Professionals we would be immune to the inequities that we see in our larger society and we also cannot afford to think that those inequities have no impact on the quality of life and health of those we are serving so what might be some of the
• 36:00 - 36:30 factors contributing to these patterns I mentioned that care process variables were important to consider Beyond just looking at patient factors and system level factors and we know that having providers who are not competent in disabilities can be a barrier to care because Health Care Providers if they have not received appropriate training and awareness May hold incorrect assumptions and stereotypes about people
• 36:30 - 37:00 with various disabilities and those assumptions can result in inadequate care and so many would argue that Disability should be a basic and critical component of any cultural compet competency training and education for health care providers and then within that work that we also look more specifically at the needs of minorities with disabilities and worked to get data that that gives us a more accurate view one objective of the healthy people 2020
• 37:00 - 37:30 is that graduate students receive training related to persons with disabilities and it also recommends that cultural competency that includes disability be required teaching and Licensing components of curricula for all medical schools and health professionals training the consequences of not having this as a requirement is that for example it's Poss I to become a board certified physician without ever having
• 37:30 - 38:00 hands-on experience with patients with developmental disabilities people with disabilities have poor health outcomes and use and have higher prevalence of secondary conditions like obesity they frequently lack insurance or the necessary coverage for needed services such as specialty care or long-term care and the care that they receive is often fragmented going to multiple providers without having
• 38:00 - 38:30 adequate coordination of services we also know that there are barriers to preventive services that can disproportionately affect people with disability Studies have shown that they are less likely to receive counseling for smoking sensation they have to deal with providers who may have stereotypes and lack of appropriate training and even the medical facilities in which they are seeking care May lack appropriate examination equipment may not have signed language
• 38:30 - 39:00 interpreters and just are not prepared to make accommodations for individuals and their unique needs and then on top of that we know that uh there are racial and ethnic disparities and people may also have limited access to health information and are excluded from health related research so definitely the disability community is a population that experiences Health disparity and within
• 39:00 - 39:30 that Community we can see further challenges for those with limited English proficiency limited health literacy racial ethnic minorities and other marginalized groups studies show that people with cognitive limitations for example are up to five times more likely to have diabetes in the general population and at the same time can potentially receive less adequate care and managing that disease disability status is as great or
• 39:30 - 40:00 greater risk for unintentional injury than age sex gender race or education and people with disabilities are one and a half times more likely to be victims of non-fatal violent crimes we also know that mental distress such as depression or anxiety is a common concern for people with disabilities and they are less likely to receive adequate social and emotional support to address those
• 40:00 - 40:30 concerns I'll now share with you some data from the Au and University of Illinois and Chicago that tells us a little more about some of the disparities by race and ethnicity that we might see within the population of those who have intellectual and developmental disabilities we see for example that among um adults with intellectual and developmental
• 40:30 - 41:00 disabilities Latinos have a much higher rate of having Fair or poor mental health and fair or poor General Health we also see higher rates of obesity among blacks and Latinos as compared to whites and we see that latinos with intellectual developmental disabilities have much higher rates of diabetes there was a study done by bsh hay and others that looked at race and
• 41:00 - 41:30 ethnicity and its relationship to use of preventive Health Care among adults with intellectual and developmental disabilities first of all we know that there is definitely a lack of research that looks at disparities um in this community so this study wanted to examine the data from the national core indicators project more closely and they found that there were differences in the rates of preventive
• 41:30 - 42:00 care by race and ethnicity but when they looked at other person level factors they did not see as much of a difference there were there was also research done looking at refugees and immigrants with intellectual and developmental disabilities this study found that strong resilience among immigrant families was definitely an a asset however there were
• 42:00 - 42:30 challenges for this population in finding accurate information on insurance and service providers challenges with coordinating multiple specialist services and experiences of a lack of cultural competence in virtually all levels of Health Service provision and access to healthc care services was thought to be definite ly improved when this community was treated by providers
• 42:30 - 43:00 who were linguistically and culturally sensitive and it was able to give them an experience favorable in comparison to their country of origin I'd like to share another uh resource with you I quoted some of the statistics that were found from the national core indicators which is a voluntary effort by public developmental disabilities a agencies to meure and track their own performance I have a screenshot here of their uh
• 43:00 - 43:30 website where you can find uh core indicators that are standard measures used across states to assess the outcomes of services provided to individuals and families and these indicators address key areas of concern including including employment service planning Community inclusion Choice health and safety uh this program began in 199 7 and it uses information from the adult
• 43:30 - 44:00 family survey and also a child family survey that's mailed to the home in addition they have a staff stability survey and I just gave an example here which shows the rate at which people report they do not get the services that they need and in general in 2014 and 15 we have 74% of of those survey reporting they do not get the services that they
• 44:00 - 44:30 need at this site um you do do have the ability to stratify and look at various race and ethnic groups and I stratified here to see how that same question was answered by blacks or African-Americans that were included in the survey and we see that um 28% sometimes do not get the services that they need
• 44:30 - 45:00 and 9% do not get the needed services so that was a little interesting difference in the expected um pattern so in General on virtually all measures of social determinance adults with disabilities Faire poorly and adults with disabilities are more likely to not have high school education much less likely for employment less likely to have access to the internet more likely to have an annual household income less than 15,000
• 45:00 - 45:30 and more likely to have an adequate transportation and those are social determinants of Health now I'd like to show you another video um and this is a tale of two lives that gives us an opportunity to see how these differences in disability can result how these differences in privilege and social determinance can result in some very
• 45:30 - 46:00 real um differences in quality of [Music] life
• 46:00 - 46:30 [Music] [Music] [Music]
• 46:30 - 47:00 [Music] [Music]
• 47:00 - 47:30 [Music]
• 47:30 - 48:00 [Music] [Music] oh [Music]
• 48:00 - 48:30 so when we think about the issue of
• 48:30 - 49:00 disparities in health and health care and social determinance of Health I mentioned that we can look at that at various levels system level factors care process variables and um patient level factors and just as we can conceptualize that Pro problem at various levels we also have the ability to address these inequities by tackling them at these
• 49:00 - 49:30 very same levels because there is something that we can do about this one of the things that we can do is ask Equity related questions when we're developing programs or we're doing research projects or Pro or developing a service protocol we should ask ourselves questions like who are who are the community stakeholders that we can exchange knowledge with how can we
• 49:30 - 50:00 engage them and learn from them thinking about the various racial ethnic and demographic groups that we talked about we should want to know are we relevant to those that we're serving are we understood and is our information being presented in a useful way when we are looking at Community groups that we can partner with we should ask is there a sense of community ownership over this shared knowledge other Equity questions might be why are
• 50:00 - 50:30 some people at greater risk where are the people we need to learn more about how can we reach and engage them in our inquiry process we need to remain open to understanding the lived experience of specific groups and engage in discussion to understand how that experience relates to health outcomes and to the goals of our program project or service and also think about how our actions
• 50:30 - 51:00 might be relevant to specific population when we think about the social and environmental conditions of a community it's important to ask what are the unique needs or challenges that they're facing and in research or quality evaluations we want to think about how we're designing our data collection and whether or not there's a way we can design that so that we can learn more about the relationships between these social determinants of
• 51:00 - 51:30 health health outcomes behaviors and knowledge It's always important to ask who is accessing and benefiting from our programs and who is not often just a simple question of who is not at the table or who are we missing can be very powerful we need to think about as we make DEC decisions about the way we're going to provide care are there barriers
• 51:30 - 52:00 or differential impacts from those decisions and if so what what what can we do to change that a great example of that might be policies that you have around how patients are seen late policies that you have or rules that you might have about followup might differentially impact sectors of our community who have limited access to Transportation or have
• 52:00 - 52:30 difficulty understanding written information or have limited English proficiency so we need to always be adjusting our Health Equity lens to think how decisions we make and care we provide might be received differently from different groups another way that we can have an impact on some of these differences that we saw is to strive towards culturally competent communication um there is a concept of
• 52:30 - 53:00 unified health communication approach which says that we need to think about communicating as a three-legged stool that rests equally on ensuring our communication takes into account health literacy limited English proficiency and cultural competency so often as very educated providers and professional we see it as our duty to transmit information to the people that we are
• 53:00 - 53:30 serving or working with but many times there are gaps in educational level or gaps in our own ability to relate to their unique social or cultural experiences so we have to always make sure that we're thinking about whether the information we are presenting is an understand it's being presented in an understandable way for those with limited health literacy English proficiency and also whether the information is being discussed in a way
• 53:30 - 54:00 that shows respect for shared decision making and allows those we are serving to share their values and perspectives as we work out a plan that's going to be most suitable and efficacious for them as we progress in our careers we often have the opportunity to lead the direction of pro programs or agencies and may have the chance to really um
• 54:00 - 54:30 lead some policy changes to make sure that the services we're providing are more culturally competent and I included this as a resource that um tells us how to work towards reducing disparities this is specific to healthcare organizations but I think the road map can be applied to many other settings which you're trying to implement organizational change and one of their recommendations is that as
• 54:30 - 55:00 we look at our various quality indicators and most agencies or organizations would have those we might want to put an equity lens on that data and just do one more bit of analysis to say we're doing a good job here but what happens when we break it down by level of income or English proficiency or race and ethnicity does it show that we're doing just as good of a job and that could be a matter of asking for one more
• 55:00 - 55:30 step of analysis when you prepare for your quarterly report so that you can share it with your team and see where there are opportunities for improvement another key step is creating a culture of equity and we'll talk more about that later this week in terms of how we can build that culture among teams but really recognizing that disparities exist and creating a culture where we take responsibility for addressing those
• 55:30 - 56:00 disparities as they show up in our daily work another area is that once we find that there are gaps in quality to be willing to have H discussions and do further analysis to understand what those contributing factors might be which can then help us design interventions to close those gaps and work with our leaders to secure buyin and resources that will help us Implement
• 56:00 - 56:30 change so now let's go to question number four the most important factor behind the 30-year increase in us life expectancy that we saw during the 20th century was and Mike if you can tell us how we responded to that 53% of participants chose B social reforms and that's very that is the correct answer because we do know that since we're focusing on social
• 56:30 - 57:00 determinance of Health um in order to have the types of positive impact that we want to have on closing disparities or gaps in quality of health and well-being it's going to take us looking at Social changes better wages housing social security job security working conditions civil rights laws sanitation and other protections that improve our health by improving our lives and those
• 57:00 - 57:30 involve social reform and they also involve addressing uh policy uh now it's very interesting to note that um federal policy does not identify people with disabilities or uh subgroups of people um with uh disabilities as uh medically understood served um populations so as a result uh medical students and residents who are
• 57:30 - 58:00 interested in working with these populations are not eligible for federal loan repayment programs and in addition there are no incentives for research and databased development because we do not have this designation so that's a great example of how policy decisions can affect our ability to advance our knowledge in this field and to provide more culturally competent uh care providers to serve this
• 58:00 - 58:30 population so in general I posed the question what are we working towards when we do this work and often people will interchange the terms equality and Equity but i' like to include this uh image to help us understand some important differences between the two in this first uh image you see that we have three children who are reaching for the same objective they all want to see the
• 58:30 - 59:00 baseball game and for our work we could say our objective is that we want everyone to enjoy a the greatest quality of life that they are able to to have the best health outcomes that they are able to uh in this first diagram you'll notice that they were all given a little bit of assistance everyone was given the same size box to stand on to try to meet that objective they're being treated
• 59:00 - 59:30 equally you'll notice however they did not all meet the desired objective when we look at the second image we see that individuals are given what they need in order for them to have equal access to viewing the game the child that was of the uh lowest height was given more so that he could see the game and have access to that the same as someone who maybe did not need
• 59:30 - 60:00 that at all this is equity however to challenge our thinking a bit more and really think more about the larger societal and structural and system issues that impact our ability to reach those outcomes we can see in the third image that if we remove some of the barriers that have been place at a system level all three can see the game without any supports or
• 60:00 - 60:30 accommodations because the inequity was addressed and the system barrier was removed so I would challenge us to think about in our work what are the boxes that we as providers might place to help people reach the outcome in spite of the barriers that they face and especially from a policy standpoint and from a leadership standpoint where are there opportunities for us to work to remove
• 60:30 - 61:00 the barriers so that everyone has access to the desired outcome and so I'll just end uh the formal uh presentation portion with this quote from Dr Martin Luther King of all the forms of inequality Injustice in healthc care is the most shocking and inhumane and now will uh pause for questions we have a question from Molly uh Molly I unmuted your microphone if
• 61:00 - 61:30 you'd like to go ahead and ask that question it seems to be a a pretty lengthy one yeah can you hear me yes we can go ahead okay mine's more of a comment um I think this is a great topic um but it was very interesting to me um with your questions to the audience because um in medical school they've actually taught us different answers than what um you presented which I think contributes um further to the biases
• 61:30 - 62:00 that you talked about um for example um the question about what's the strongest predictor of somebody's Health in medical school they've taught us the answer is whether or not you smoke um and then for question four the biggest contributor to the um increasing life expectancies we've learned it's the development of modern hospital system
• 62:00 - 62:30 and Technologies is the most important contributing factor um so I just found that very very interesting um just the discrepancy between this presentation and what they're telling them in medical school and it's you know kind of just overlooking um all of these determinants and how they really do affect um patients and things like that that so just a very interesting observation that that's a great point and I think that when we don't stratify
• 62:30 - 63:00 the data by race ethnicity and zip code and these other variables that we discussed often we don't notice these differences so it will be very interesting to forecast 10 years from now to see if that is still being taught um but I you know when we look at data like the ntion Health Care disparities report it makes it very clear that in spite of the
• 63:00 - 63:30 technological advances not everyone is progressing at the same rate so I think it really highlights um we know the data can be a tricky thing it all depends on the questions that you ask and that's why I really emphasize that that if we don't ask the question we won't know so I really appreciate that point that's that's really important that you made thank you my my basic uh comment is I think that if your head is spinning a little bit after this session I feel like I've
• 63:30 - 64:00 uh done my job because we really want to challenge you to ask more questions uh about the data that you're seeing and the people that you're seeing and really try to think about them in context um I think the the most important question you can ask as I said is is the service I'm providing affecting one population differently who's missing at the table
• 64:00 - 64:30 if you start to see patterns that are different than you expect ask why might this be occurring and really challenge yourself to think about what do I need to understand about where this patient lives works and plays and how their access to housing Transportation healthy food and a host of other social deter of Health might be impacting the way they are presenting to you the patterns of
• 64:30 - 65:00 health health seeking that you see and the way that they are managing their condition or advocating um for their condition great thank you everyone