Minority Health &
Health Disparities
UCSD School of Medicine
Sandra Daley, M.D.
May 24, 2005
Objectives
Define health disparities
 Provide evidence of health disparities
 Describe efforts to reduce health
disparities and describe anticipated
outcomes of current efforts

Health Disparities
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National Institute of Health
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“Health Disparities are differences in the incidence,
prevalence, mortality, and burden of diseases and other
adverse health conditions that exist among specific
population groups in the United States”
Health and Human Services Agency
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One of Healthy People 2010’s overarching goals is to
eliminate health disparities.
Leading Health Disparities
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Cardiovascular
Disease
Cancer
Diabetes
HIV/AIDS
Infant Mortality
Asthma
Mental Health
National Institute of Medicine
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
Video Module: Worlds Apart
Robert Phillip’s story
Evidence of Racial and Ethnic
Disparities in Healthcare
Disparities consistently found across a
wide range of disease areas and clinical
services
 Disparities are found even when clinical
factors, such as stage of disease
presentation, co-morbidities, age, and
severity of disease are taken into
account

National Institute of Medicine
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
Evidence of Racial and Ethnic
Disparities in Healthcare cont.,
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Across a range of clinical settings
including:
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public and private hospitals
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teaching and non-teaching hospitals
Disparities in care are associated with
higher mortality among minorities (e.g., Bach
et al., 1999; Peterson et al., 1997; Bennett et al., 1995)
At-risk Populations
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Rate of suicide in adolescents has tripled in the
last 30 years
In San Diego compared to national data, higher
percentage of youth report suicide attempts in
the last 12 months (YRBS 2003)
Gay adolescents are 2-3 times more likely than
peers to attempt suicide
Self-identified GLB youth are at increased risk for
mental and physical health problems (Lock J 1999)
Women are at greater risk for Alzheimer disease
than men and are twice as likely as men to be
affected by major depression
At-risk Populations cont.,
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The Appalachian region suffers an excess
in premature deaths (among persons ages
35 to 64) from heart disease, all cancers
combined, lung cancer, colorectal cancer,
chronic obstructive pulmonary disease,
diabetes, and motor vehicle accidents,
relative to comparable non-Appalachian
U.S. population.
African Americans
Experience a more than double infant
mortality rate
 Have a 30% higher death rate for all
cancers
 Are more than seven times more likely to
die from HIV/AIDS
 Are five times more likely to develop the
most common type of glaucoma and are
six times more likely to become blind
from glaucoma
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Hispanics and Latinos
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Are almost twice as likely to die from
diabetes
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Accounted for 20% of new cases of TB,
despite only comprising 11% of the
population in 1996
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Have higher rates of high blood
pressure and obesity
American Indians & Alaskan Natives
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Have diabetes rates that are more than
two times higher
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Have disproportionately high death rates
from unintentional injuries and suicide
Asian Americans & Pacific Islanders
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Have higher rates of new cases of
hepatitis and tuberculosis
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Demonstrate signs of being a healthy
population, on average, but exhibit great
diversity within the population. For
example, Vietnamese women suffer from
cervical cancer at nearly five times the
rate of Caucasian women
Disparities in Medical Diagnosis and
Treatment
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Hispanic patients with long bone fractures are
twice as likely as non-Hispanic whites to receive
no ED pain medication (Todd et al., 1993).
Black patients with long bone fractures are 1.66
times as likely as non-Hispanic white patients to
receive no ED pain medication (Todd et al., 2000).
Blacks are less likely to be referred for cardiac
catheterization than whites, despite identical
clinical presentations and lab/EKG data (Shulman
et al., 1999).
Minorities less likely to be screened for cholesterol
levels (Naumburg et al., 1993).
Reasons for Disparities
in Health
Explanations for Health Disparities
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Methodological differences
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Socioeconomic differences
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Data collection
Health services access
Education and behavior
SES and living/working
environments
Biological differences
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Anatomical/physiologic
Genetic
Explanations for Health Disparities
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Sociocultural differences
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Patient health-related behavior
 Diet
 Substance
use
 Occupation
 Leisure activity
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Professional Competencies
 Patient
Explanatory models
Efforts to Reduce
Disparities in Health
National Institutes of Health (NIH)
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New Institute created at NIH: National
Center on Minority Health and Health
Disparities (NCMHD)
San Diego EXPORT Center
Excellence in Partnerships for Community
Outreach, Research on Disparities in Health
and Training
COUNCIL OF
COMMUNITY CLINICS
REHDI
County of San Diego, HHSA
EXPORT Center Goals
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Promote participation of health disparity groups in
research, prevention, intervention &
dissemination activities
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Enhance research on HIV and CVD diseases that
targets the African American and Latino
populations.
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Increase number of scientists, graduate &
undergraduate students engaged in health
disparities research
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Disseminate culturally sensitive information on
disease prevention in minority communities via
clinics and print media network in San Diego
Health Disparities Education
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San Diego EXPORT Centers HD Education
Core efforts include:
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Implement a joint minority health disparities
curriculum for UCSD SOM & SDSU graduate
students in public health
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Develop and propose a new curriculum for
medical students with an area of concentration
and potential dual degree in Health Equity
under the University of California PRIME
initiative
University of California’s PRIME
PRIME – Program in Medical Education
To produce culturally & linguistically
competent physicians
 To train physicians to address the needs of
underserved communities
 Expanded medical school enrollment with
focused programs of excellence &
specialized curricula
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UCSD’s PRIME-HEq
Program in Medical Education Health Equity
UCSD PRIME-HEq
Inclusive program that trains physicians to
provide better health care services to
underserved and at risk populations
 Provides a new option for dual degrees in
minority health and health disparities
 Evolves from community/university
partnerships formed over the last two
decades
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Potential PRIME-HEq Dual Degrees
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Public Health
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Leadership of Healthcare Organizations
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Humanities
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Bioengineering
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Advanced Studies in Clinical Research
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Business Administration
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Advanced Studies in Law & Medicine
Benefits of Health Science Pipeline and
PRIME-HEq
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Attracts a diverse
population of highly
qualified students
Expands dual degree
opportunities
Increases the number of
physicians providing
services to underserved
populations
UCSD Trained Physicians in PRIME
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Provide health care to underserved and at
risk populations and are excellent
clinicians prepared to be:
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Physician/Advocates,
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Physician/Scholars, and
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Physician/Healers
Public & Private Investment to
Eliminate Health Disparities
Provide latest research-based information
to health care providers to enhance the
care provided to populations at risk for
health disparities
 Introduce science based information into
the curricula of medical and allied health
professions schools and continuing
medical education for health professionals
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Establish and maintain ongoing
communication and dialogue with
underserved populations who experience
health disparities
 Develop computer databases and internet
resources to disseminate current
information about scientific research,
discoveries and other activities
 Develop targeted public health education
programs
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Objectives
Define health disparities
 Provide evidence of health disparities
 Describe efforts to reduce health
disparities and describe anticipated
outcomes of current efforts

Questions?
http://meded.ucsd.edu/sdexport