Please cite appropriately.
• Phillips, K.G., & Drum, C.E. (2013, October).
Disability as a Health Disparity Minority Group.
Session [or poster, if applicable] presented at
Southwest Conference on Disability,
Albuquerque, NM.
Available online at:
http://iod.unh.edu/Projects/health_disparities/oth
er_materials.aspx
7/24/2014
1
Disability as a
Health Disparity
Minority Group
Kimberly Phillips, MA
Charles E. Drum,
MPA, JD, PhD
Overview
• Define Health Disparities
• Consider Ansari’s (2003) Public Health Model
of the Social Determinants of Health
• Apply to Behavioral Risk Factor Surveillance
System Data
• Discuss Disability and Racial/Ethnic Group
Comparisons
7/24/2014
3
Disclaimers
• Research funded by the National Institute on
Disability and Rehabilitation Research, Grant #
H133A100031, but contents do not reflect the
formal position of NIDRR
• No reference to drugs or products are
included in this presentation
7/24/2014
4
WHAT ARE HEALTH DISPARITIES?
Health Disparities
•
Health differences closely linked
with social, economic, and/or
environmental disadvantage
•
Adversely affect groups of people
who have systematically
experienced greater obstacles to
health based on:
U.S. Department of Health and Human Services. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for
2020. Phase I report: Recommendations for the framework and format of Healthy People 2020. Section IV. Advisory Committee findings and
recommendations. Available at: http://www.healthypeople.gov/hp2020/advisory/PhaseI/sec4.htm#_Toc211942917
Health Disparity Populations
• Racial or ethnic group; religion;
socioeconomic status; gender; age; mental
health; cognitive, sensory, or physical
disability; sexual orientation or gender
identity; geographic location; or other
characteristics historically linked to
discrimination or exclusion.
(Healthy People 2020)
7/24/2014
7
Mere Difference or Disparity?
“Outcomes for which it can be determined
quantitatively --- rather than merely anecdotally or
associatively --- that the fact of pre-existing disability
status serves as a dominating independent variable
…as opposed to merely one of many independent
variables of varying epidemiologic force.”
(The CDC Traditionalist)
7/24/2014
8
What Causes Health Disparities?
•
Social, economic, and/or environmental
disadvantage
• Inadequate policies and standards
• Inadequate funding
(Fox, 2012)
World Report on Disability, World Health Organization, 2011,
http://www.who.int/disabilities/world_report/2011/en/index.html
What Causes Health Disparities?
•
Systematically experiencing greater obstacles
to health
• Problems with service delivery
• Lack of accessibility
(Fox, 2012)
What Causes Health Disparities?
•
Characteristics historically linked to
discrimination or exclusion
• Negative attitudes
• Lack of consultation and involvement
• Lack of data and evidence
(Fox, 2012)
MEASURING DISPARITY
7/24/2014
12
Health Indicators
•
•
•
…measure health status
…contribute to a person's current state of
health, defined as a state of complete
physical, mental, and social well-being and not
just the absence of sickness or frailty.
…may be biological, socioeconomic,
psychosocial, behavioral, or social in nature.
Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, N.Y., 19-22 June, 1946;
signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered
into force on 7 April 1948.
Public Health Model of Social
Determinants of Health
Health care system
attributes
Health outcomes
Morbidity
Mortality
Integrated measures of health
Social determinants
Disease inducing
behaviors
(Ansari et al., 2003)
7/24/2014
14
Interrelation of Social Determinants
Socio-economic
determinants
Community &
societal
characteristics
Psychological risk
factors
(Ansari et al., 2003)
7/24/2014
15
BRFSS DATA
7/24/2014
16
Behavioral Risk Factor Surveillance
System (BRFSS)
• State-based, random digit dialed telephone
health survey conducted in all 50 states, DC,
and U.S. Virgin Islands, Guam, American
Samoa, and Palau
• Demographics and information on health,
health behaviors, and prevention activities
• Weighted to be nationally representative
7/24/2014
17
BRFSS
• Analysis based on 2011 data (N = 506,000
before weighting)
• Limited to ages 18 – 64 (N = 321,456)
• BRFSS Limitations
7/24/2014
18
BRFSS Disability Definition
1. Are you limited in any way in any activities
because of physical, mental, or emotional
problems?
2. Do you now have any health problem that
requires you to use special equipment, such as a
cane, a wheelchair, a special bed, or a special
telephone?
7/24/2014
19
Prevalence of Disability
7/24/2014
20
Prevalence of Race / Ethnicity
7/24/2014
21
SOCIAL DETERMINANTS
7/24/2014
22
Socio-economic
7/24/2014
23
Socio-economic
7/24/2014
24
Psychosocial
7/24/2014
25
Community & Societal
7/24/2014
26
HEALTH CARE SYSTEM ATTRIBUTES
7/24/2014
27
Access to Health Care
7/24/2014
28
DISEASE INDUCING BEHAVIORS
7/24/2014
29
Smoking & Inactivity
7/24/2014
30
Diet & Alcohol
7/24/2014
31
HEALTH OUTCOMES
7/24/2014
32
Self-reported Health
7/24/2014
33
Obesity & Diabetes
7/24/2014
34
Cardiovascular Disease & Cancer
7/24/2014
35
DISABILITY & RACE / ETHNICITY:
COMPARING THE GROUPS
7/24/2014
36
Social Determinant
2
3
1
7/24/2014
37
System Attribute
1
3
2
7/24/2014
38
Disease Inducing Behavior
3
1
2
7/24/2014
39
Health Outcome
1
3
2
7/24/2014
40
INTERSECTION OF
DISABILITY & RACE / ETHNICITY
7/24/2014
41
Prevalence of Disability in
Racial / Ethnic Groups
Race / Ethnicity
Black
Asian
AI/AN
NH/PI
Other
Hispanic
Disability Prevalence
22.0
10.2
23.4
32.7
31.7
15.9
Social Determinant - Poverty
7/24/2014
43
System Attribute - Delayed Care
7/24/2014
44
Disease Inducing Behavior - Smoking
7/24/2014
45
Health Outcome – SRH Fair/Poor
7/24/2014
46
SUMMARY & CONCLUSION
7/24/2014
47
Summary
• Individuals with disabilities experience
significant health disparities compared to the
non-disabled population
• Individuals with disabilities experience high
rates of disparities compared to non-disabled
Racial / Ethnic minority groups
• Minorities with disabilities experience high
rates of health disparities
7/24/2014
48
Conclusion
• Infusion of disability population into
mainstream public health limited
• Important to establish onset and
disentangle disability from disease and
other health outcomes
• Disparity research is under-funded
• and limited
7/24/2014
49
Questions Later?
Kimberly.Phillips@unh.edu
603-862-4320
7/24/2014
50