Instructions: Present your work professionally, without typos or grammar errors. Do not plagiarize. Use complete sentences, avoid colloquialisms and cite your sources. If you need assistance in writing, do not hesitate in getting the assistance of the CU Writing Center at http://www.ucdenver.edu/academics/colleges/CLAS/Centers/writing/Pages/TheWritingCenter.aspx (Links to an external site.)Links to an external site.
1. Define health inequities (cite your source; do not cite directly the Quest for Health Equity book, but you can use one of the references in the book) and describe the institutionalized, personally-mediated and internalized causes of disparities.
The World Health Organization defines health inequity as "the presence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification". Health equity. (2017, October 05). Retrieved September 3, 2018, from http://www.who.int/topics/health_equity/en/
Institutionalized causal framework for health inequities includes laws and policies especially those targeting minority groups, as well as social determinants of health and socioeconomic status. Additionally, this includes racism.
Personally mediated: can be intentional or unintentional acts of commission and omission that assist in maintaining structural barriers and are condoned by societal norms. This can include internal biases and discrimination; for instance, judging job applicants unfairly based on the color of skin or socioeconomic status. Rather than giving them equal opportunities, or an opportunity for growth, this confines them to their current status.
Internalized: Reflects systems of privilege and societal values, erodes the individual sense of value, and undermines collective action. An example of this may be ethnically diverse people shedding their culture to assimilate into white culture, believing that it is "better".
2. Define social determinants of health and provide at least five (5) examples of social determinants (e.g., poverty).
Social determinants of health are the environmental factors and conditions in which people live, work, learn, and play that determine health. These include neighborhood and location, economic stability, education level, access to healthcare, and social and community support.
Social Determinants of Health | Healthy People 2020. (2018). Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health
3. Search the literature and find three ORIGINAL articles or reports (NO reviews, editorials, fact sheets, infographs) describing a DIRECT association between a social determinant of health and a health condition (e.g., people who are poor are more likely to die of cancer). The articles or reports MUST be found in any of the following sources:
Per Healthy People 2020, diabetics with a highschool education, or less, have the most adverse outcomes. Education is a social determinant of health, and level of education often opens many doors. This can be in terms of being able to earn higher paying jobs and thus being able to afford taking care of themselves in terms of healthier food and the necessary supplies or costly medication. To further this, a higher income can allow for people to live in safer neighborhoods, opening opportunities to safe recreation and exercise, or allowing their families to play outside unwatched, while adults can stay home and cook healthier foods for themselves and their families. Additionally, higher education level can also allow for better in-school education of healthy lifestyles and nutrition.
Healthy People 2020. (n.d.). Chapter 8: Diabetes. Retrieved October 10, 2018, from https://www.cdc.gov/nchs/data/hpdata2020/HP2020MCR-C08-Diabetes.pdf
Per the Kaiser Family Foundation, those who are living in impoverished or low-income communities are more susceptible to non- communicable diseases such as cardiovascular disease, cancer, chronic respiratory diseases, and diabetes. Nearly double the amount of people earning low- incomes died from non- communicable diseases in 2016 than did those earning high-incomes. This is because poverty influences access to affordable and quality food. With limited access to fresh foods, cheap and fast foods that are often times significantly more unhealthy, are consumed more often for the sake of convenience. These contribute to obesity and heart disease, and further raise levels of cholesterol.
Kaiser Family Foundation. (2018, September 14). The U.S. Government and Global Non-Communicable Disease Efforts. Retrieved October 10, 2018, from https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-global-non-communicable-diseases/
Per a RAND corporation report, the elderly living in rural areas have higher rates of dementia than the elderly living in urban areas. As part of their built environment, the residents of rural areas have limited access to public health interventions and healthcare, however, even when they do have access, it is typically of poorer quality than their urban counterparts. The rural community may also have differences in education level which may translate into cognitive ability in the later years of their lives. As compared with adults in urban areas, those living in rural areas typically have lower education level and do not finish their advanced degrees as frequently.
W., M., S., A., R., U., M., L., & M., K. (2017, December 20). Dementia Is More Prevalent Among Rural Seniors. Retrieved October 10, 2018, from https://www.rand.org/pubs/external_publications/EP67436.html
4. Define cultural competence/ (aka sensitivity, humility). Cite your source (do not cite the Quest for Health Equity book, but you can use one of the references in the book).
“Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations.
The word culture is used because it implies the integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values and institutions of a racial, ethnic, religious or social group. The word competence is used because it implies having the capacity to function effectively.â€
Cross, T., Bazron, B., Dennis, K., & Isaacs, M. (2018). Towards A Culturally Competent System of Care: A Monograph on Effective Services for Minority Children Who Are Severely Emotionaly Disturbed. Retrieved from https://spu.edu/~/media/academics/school-of-education/Cultural%20Diversity/Towards%20a%20Culturally%20Competent%20System%20of%20Care%20Abridged.ashx
5. Visit the latest National Healthcare Disparities and Quality Reports at https://www.ahrq.gov/research/findings/nhqrdr/index.html (Links to an external site.)Links to an external site. (they now have the 2017 report) and provide five examples of health disparities (cite the actual statistics/numbers)
15.5% of poor people under age 65 were uninsured all year, while only 4.2% of high-income people under the age of 65 were uninsured all year.
17.1% of Black adults who needed immediate care for an illness, injury, or condition in the last 12 months did not get care ever or as urgently as they needed, while only 10.5% of white adults did not get care ever or as urgently as they needed.
Among adults ages 18-64, 8.5% of Blacks were uninsured, while the rate for whites was only 8.5%.
74.6% of AI/ AN people under the age of 65 had health insurance, while this was 89.8% for Whites.
Among children ages 0-17, 7.5% of poor children lacked health insurance, while only 3.8% of children that were not poor lacked health insurance.
6. Define unconscious bias, describe how it can be measured and discuss its impact in health inequities
Unconscious bias is implicit and not intentional, and can be for race, culture, and gender. The most common way to measure this is Harvard’s Implicit Association Test (IAT). In terms of health inequities, this looks like providers failing to mention a certain course of treatment to someone who identifies with a particular ethnic or cultural group based on their culture statistically failing to adhere to treatment. Implicit bias can also be shown in provider communication with minority patients and poor ratings of interpersonal relationships. Implicit bias furthers health inequity by treating people differently and providing them with different qualities of care. If a patient perceives bias, they may not feel welcome enough to return, in turn, not receiving the care they need.