Gender, Race/Ethnicity, Poverty & Health:
Do We Need to Untangle the Web to Take Action?
Marsha Lillie-Blanton
The Henry J. Kaiser Family Foundation
GWU School of Public Health and Health Services
AcademyHealth Annual Research Meeting
June 29, 2009
1
Setting the Stage:
Key Facts and Figures
2
Income & Race/Ethnicity Shape Patterns of
Health & Health Coverage: Nonelderly Population
42%
Non-Poor (200% + of
FPL)
43%
46%
59%
68%
74%
Near Poor (100-199%
of FPL)
Poor (<100% of FPL)
29%
23%
21%
20%
16%
14%
29%
34%
33%
21%
17%
12%
White, nonHispanic
Hispanic
166.6
million
40.8
million
African
Asian and
American
American, non- Pacific Islander Indian/Alaska
Hispanic
Native
32.6
million
11.8
million
1.5
million
Two or More
Races
4.2
million
NOTES: Individuals who reported more than one race group were categorized as “two or more races.” Nonelderly includes individuals < age 65.
FPL= Federal Poverty Level. The FPL for a family of four in 2005 was $19,971.
DATA: March 2006 Current Population Survey.
SOURCE: Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates.
Poverty Among Women Varies by Race/Ethnicity & State
Population of
Women
American Indian
and Alaska Native
Poverty
All States
Lowest
Rate State
Highest
Rate State
32.8%
31% - NC
52% - SD
African American
28.5%
16% - WA
45% - ID
Hispanic
27.4%
17% - MA
37% - RI
Asian American,
Native Hawaiian,
Pacific Islander
White
15.0%
8% - FL
25% - SC
11.9%
8% - NH
19% -WV
SOURCE:. derived from Kaiser Family Foundation, 2009 Putting Women’s Health Care Disparities on the Map
What’s Happening to Men of Color
• Unemployment Rates, ages 20+:1
– AA men: 16.6%
– AA women: 11.1%
– Hispanic men: 11.1%
– White men: 8.7%
• Prison & Jail Incarceration Rates: 2
– AA men: 4.8% in prison or jail
– Hispanic men: 1.9% in prison or jail
– White men: 0.7%. in prison or jail
• Homicide Rates, Ages 15-24:3
– AA males 15-24 was 85 per 100,000
– Hispanic males: 30 per 100,000
– White males: 5 per 100,000
NOTE: AA is African American
SOURCE:. 1) U.S. Bureau of Labor Statistics: data for May 2009; 2) U.S. Bureau of Justice Statistics: data for 2006; 3)
Health U.S. 2005: data are for 2003
Social Inequalities and Health
6
Socioeconomic and Racial/Ethnic
Differences in Health are Linked
SOURCE: Braveman et al 2008. RWJF Commission to Build a Healthier America
Summary of Worse-than-Average Dimension
Scores, by State: Health, Access, Social Factors
NH
VT
WA
ME
ND
MT
MN
OR
ID
WI
SD
RI
MI
CT
WY
PA
IA
NE
NV
IL
UT
CA
CO
OH
IN
VA
KS
MO
KY
NC
OK
NM
SC
AR
MS
TX
AL
GA
LA
AK
FL
HI
Worse than Average on 0 Dimensions (19 states)
Worse than Average on 1 Dimension (16 states)
Worse than Average on 2 Dimensions (9 states and DC)
Worse than Average on 3 Dimensions (6 states)
SOURCE:. derived from Kaiser Family Foundation, 2009 Putting Women’s Health Care Disparities on the Map
NJ
DE
WV
TN
AZ
MA
NY
MD
DC
What’s Happening in the Health System:
African Americans and Latinos with
Public Coverage or Uninsured
INSURANCE
COVERAGE
AFRICAN AMERICANS
LATINOS
U.S. Population, 2007
~ 37.8 million
~ 46.0 million
Public Coverage
~ 14.7 million
~ 14.0 million
Medicaid
~ 9.0 million
~ 10.3 million
Medicare
~ 4.3 million
~ 2.9 million
Military (VA & DOD)
~ 1.4 million
~ 0.8 million
~ 7.4 million
~14.8 million
Uninsured
Total
(Percent)
~ 22.1 million
~ 28.8 million
(~ 58% of U.S. African American population)
(~63% of the U.S. Latino population)
SOURCE:. Table HI01. Health Insurance Coverage Status and Type of Coverage by Selected Characteristics: 2007. Current Population Survey,
U.S Census Bureau. http://www.census.gov/hhes/www/macro/032008/health/h01_000.htm
Causes of Disparities in Health
10
Quantifying Potential Sources of Health Disparities*
Environmental
Exposures
5%
Medical Care
10%
Socio-Economic
Circumstances
15%
Genetic
Predisposition
30%
Personal Behaviors
40%
* As measured by premature mortality.
SOURCE: Derived from McGinnis et al., March/April 2002. Health Affairs.
Beyond Biological Factors, What Places
Individuals at Risk of Risks?
•
In a study examining the contribution of socio-economic
factors to disparities between racial/ethnic groups
•
Risk of poorer outcome increased with census tract poverty
for virtually all outcomes
•
Racial/ethnic disparities among AA and Hispanics compared
with Whites, after adjusting for census tract poverty were:
• Approximately halved for: childhood lead poisoning; gonorrhea, TB,
HIV/AIDS mortality, and homicide
• Reduced substantially for low-birth weight, syphilis, chlamydia,
nonfatal firearm related injuries, lung and cervical cancer, and
diabetes mortality
Source: Krieger et al 2005, AJPH
Do We Need to Untangle the
Web to Take Action?
13
We Aren’t Waiting
• An extensive literature has documented
racial/ethnic, and socioeconomic disparities in
health care and health
• Widespread efforts underway in Federal, state
and local governments, academia, non profits,
foundations, local community initiatives
• Social determinants of health disparities are
complex and interrelated, thus requiring
multifacted, collaborative solutions at the
national and local levels
Building on Current Efforts and Scaling-Up
• Promote integrated and yet tailored policy framework:
Address healthcare access & quality problems that exist throughout the
system but are deeper and more persistent for people based on race and
income
• Strengthen collaborations to address social determinants:
Energy is there, but efforts often take place in silos, underfunded or
disconnected from each other & policy making
• Use creative funding mechanisms: Tax Incentives/credits,
public/private partnerships
• Adopt Regulatory requirements: Monitor and reward best
performers
• Evaluate what works and spread best practices