Multiple Determinants of Health Framework - Essay Example

Multiple Determinants of Health Framework Introduction: In the current advent of globalization and cutting edge technology, heath care has made significant progress. However, there are certain issues related to health care which have been prevalent in our society since time immemorial. One such issue is health disparity or health inequality. By definition, the term ‘health disparity’ refers to unequal provision of and access to health care facilities (including diagnostic and treatment modalities and specialized, trained health care personnel) among different social, ethnic or racial groups (Adler & Stewart, 2010). This paper discusses Cardiovascular Disease in the African American community and different factors which influence the provision of health care, especially in relation to cardiovascular diseases, in this subset of population. These include social, physiological, environmental and psychological factors and health behaviors, all of which contribute to the existing disparity in health care. In order to overcome this issue, specific measures need to be taken on the part of not only the government and health care professionals, but also by the individuals belonging to these minority groups. Some of the specific reforms in the existing system that need to be introduced include introduction of managed care programs or prepaid health care plans, introducing social reforms, improving access to health care promoting patient self-empowerment since CVD is a chronic health issue, and improving patient-clinician interaction. Background: The African American population is the second largest minority population in the United States and contributes to around 13.5% of the entire US population (U.S Department of Health and Human Services, 2009). Being a minority population, the African Americans are at a social, psychological and environmental disadvantage which is reflected by the statistics that follow in the upcoming discussion. Several population based surveys have revealed that Blacks exhibit higher mortality rates from heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, HIV/AIDS, and homicide as compared to Whites (U.S Department of Health and Human Services, 2009). With respect to cardiovascular diseases, the African American population has been shown to have a higher prevalence of cardiovascular diseases and a 30% higher risk of cardiovascular mortality as compared to the non-Black U.S population (U.S. Department of Health and Human Services, 2010). Moreover, they have been found to have a more adverse risk factor profile for cardiovascular diseases; being 1.5 times more likely to be hypertensive and 10% less likely to have adequate control of B.P even after treatment, 0.7 times more likely to be dyslipidemic, 1.7 times more likely to be obese and 1.1 times more likely to be smokers as compared to their White counterparts (U.S. Department of Health and Human Services, 2010). These adverse health outcomes for African Americans are a result of several contributing factors and determinants. These include genetic factors, social factors (e.g. literacy level), economic factors (e.g. socioeconomic status, access to health care), geographical factors and health behaviors. Analysis and Recommendations: This section discusses the different determinants of cardiovascular disease outcomes amongst African Americans and then proposes specific interventions and recommendations to overcome the existing health issues in this subgroup of population, critically analyzing their strengths and limitations. Economic factors are amongst few of the most important factors which influence cardiovascular health outcomes in the African American community. Economic factors, such as an individual’s socioeconomic status (SES) have been shown to influence not only a person’s psychological status but also their physical health. Interestingly, not only a person’s current SES but also their childhood SES has a significant impact on their health outcomes. It has been observed that low socioeconomic status during childhood is associated with a 2.4 times higher risk and an overall higher incidence of cardiovascular diseases (CVD) and poorer outcomes including higher mortality from these illnesses (Cohen, Janicki-Deverts, Chen, & Matthews, 2010). Moreover, studies have also found that the risk of CVD increased with the number of years of exposure to low SES. It is a well known fact that racial minorities are socioeconomically disadvantages. Surveys have revealed that the African Americans (Blacks) in the U.S have a lower median income and education level and higher unemployment rates as compared to their White counterparts (U.S Department of Health and Human Services, 2009). The impact of low SES is multifold. Poverty is associated with limited access to health care, due to inadequate resources. It was found that in the year 2002, more than 20% of the African American population was uninsured (Frist, 2005). Lack of health insurance due meager resources compounded by limited resources for out-of-pocket costs, greatly limits the access to appropriate health care facilities when required. This is especially pertinent in the case of chronic diseases such as CVD in which regular, timely follow-ups are required to monitor the disease status and progression and to adjust medications. Similarly, low SES is oft accompanied by lower literacy levels and thus a poorer understanding of one’s health status. For example, it was found that when offered invasive procedures such as cardiac revascularization with either coronary artery bypass graft (CABG) surgery percutaneous transluminal coronary angioplasty, for the treatment of ischemic heart disease, Blacks were more likely to opt for more non-invasive treatment modalities (Katz, 2001). Such health behaviors are molded in part by the lack of education and awareness which promotes unnecessary fears and misconceptions regarding treatment, in addition to other cultural influences and prevalent health beliefs. Another important group of factors affecting health care and outcomes is social factors. A variety of social norms and trends are prevalent in the society which either advertently or inadvertently promote bias against minorities. For example, it has been found that among the physician group accessed by the African American population, the number of board certified physicians is lower than that of the White population (Frist, 2005). Moreover, Blacks have been found to have limited access to specialized health care facilities. Similarly, there exists a communication gap when non-Black physicians cater to Black patients either due to a language or cultural barrier. It was found that collectively, Blacks and Hispanics amounted to only less than 10% of all health care practitioners in the U.S although they comprised approximately 20% of the patient population (Katz, 2001). Therefore, patient understanding of one’s disease and satisfaction with the health care received is low which eventually culminates in poorer outcomes. Another important determinant of health outcomes is health behaviors which are influenced by both social and economic factors and contribute significantly towards outcomes (Adler & Stewart, 2010). Health behaviors related to adverse cardiovascular outcomes include smoking, sedentary lifestyle, leading to obesity and high cholesterol diet, leading to dyslipidemia. As pointed out above, African Americans have a more adverse risk factor profile for cardiovascular diseases including higher prevalence of smoking, hypertension, dyslipidemia and obesity, all of which are modifiable risk factors. A third group of factors is geographical factors. It has been found that there is a paucity of specialized health care facilities in the areas where the African Americans are found to reside in majority. Statistics reveal that one-third of African American do not live in the main metropolitan areas and thus, they have limited access to specialized health care facilities such as cardiac revascularization procedures in the case of cardiovascular diseases (Frist, 2005). With respect to health behaviors, statistics reveal that African Americans are (U.S. Department of Health and Human Services, 2010). Keeping in mind all these factors, we now discuss what strategies and interventions need to be made in order to overcome this health issue. Firstly, at the level of health care delivery and improving the quality of care provided, several measures can be undertaken. Since affordability is a major factor affecting access to health care, managed care programs or prepaid health care plans need to be introduced. Schneider et al. (2001) in their study of racial disparities in influenza vaccination coverage found that the patients enrolled in managed care programs had significantly higher rates of influenza vaccination as compared to those who were in the fee-for-service group. However, although this study found that managed care improved the utilization of health care facilities, it also found that despite the provision of managed care, the racial disparity between the African Americans and the rest of the U.S population still persisted (Schneider, Cleary, Zaslavsky, & Epstein, 2001). This shows that there are factors apart from affordability and lack of insurance which influence health care access. These factors include, and are not limited to, lack of infrastructure, e.g. lack of transportation facilities and excessive travel time; preconceived notions and misconceptions regarding certain health care behaviors or adverse effects related to treatment and lack of awareness regarding the importance of promoting positive healthy behaviors and timely access of health care (Schneider, Cleary, Zaslavsky, & Epstein, 2001). In addition to managed care programs, the government can introduce reforms which enable the underprivileged population to afford health coverage. For example, The Closing the Health Care Gap Act, introduced in 2004, allowed refundable tax credits for Americans belonging to low SES (Adler & Stewart, 2010). Such incentives can improve accessibility of health amongst minority groups. However, they have limited feasibility, because as discussed above, health care accessibility is multifactorial and controlling a single factor alone would not produce any significant results. Secondly, at the societal level, the existing social and economic inequities need to be addressed. This can be achieved by introducing health care programs which provide equal health care facilities and standardized treatments to all individuals regardless of their SES. An example of one such program which has been implemented in the past is the Hypertension Detection and Follow-up Program in which all the patients were provided with the same level of care regardless of their SES and it was found that the existing disparity in mortality rates due to HTN amongst Black and non-Black populations can be overcome by the provision of standardized care. To bring about social change, health care providers should participate in programs and media campaigns promoting awareness regarding the social determinants of health and how they can be overcome. Moreover, social reforms and incentives apart from health care need to be introduced. For example, a report entitled ‘Beyond Health Care: New Directions to a Healthier America’ issued by the Robert Wood Johnson Foundation suggest introducing measures such as funding food-stamp programs and investing in early education for overcoming the existing social disparity that prevails in the society (Kim, Kumanyika, Shive, Igweatu, & Kim, 2010). Similar reforms need to be introduced to improve minority social status which in term is an important determinant of several health related behaviors and outcomes. Finally, at the level of the patient-clinician interaction, measures should be taken for better communication and interaction between patients and their health care providers. If possible, the cultural and language barrier can be overcome by providing physicians belonging to the same racial group to cater to the needs of a certain sect of people. Moreover, as noted above, since health behaviors were a significant contributing factor, the focus of intervention should not be limited to the treatment of diseases but also should have a preventive aspect. Media campaigns and other programs should be introduced which promote healthy behaviors related to cardiovascular outcomes amongst African Americans, such as smoking cessation, healthy diet and regular exercise. Moreover, since cardiovascular diseases are chronic diseases, patient empowerment in their own health care and promotion of personal responsibility are also important strategies which can improve health outcomes. Patients should be educated regarding their disease and should be encouraged to become self-empowered. For example, in the case of CVD, patients themselves should be encouraged to routinely monitor their blood pressure, adopt healthy lifestyle modifications, adhere to their medication regimen and should follow up with their physicians on a regular basis. Conclusion: Thus, in conclusion, the African American population has been found to be at an increased risk of adverse cardiovascular health related outcomes. These adverse outcomes have resulted from a variety of factors including social, physiological, environmental and psychological factors and health behaviors. Some of the proposed reforms which need to be introduced in order to improve CVD outcomes in African American population include, introduction of managed care programs or prepaid health care plans, introducing social reforms, improving access to health care promoting patient self-empowerment since CVD is a chronic health issue, and improving patient-clinician interaction. References Adler, N. E., & Stewart, J. (2010). Health disparities across the lifespan: Meaning, methods,and mechanisms. Annals of the New York Academy of Sciences , 5-23. Cohen, S., Janicki-Deverts, D., Chen, E., & Matthews, K. A. (2010). Childhood socioeconomic status and adult health. Annals of New York Academy of Sciences , 37-55. Frist, W. H. (2005). Overcoming Disparities In U.S. Health Care. Health Affairs , 445-451. Katz, J. N. (2001). Patient Preferences and Health Disparities. Journal of American Medical Association , 1506-1509. Kim, A. E., Kumanyika, S., Shive, D., Igweatu, U., & Kim, S.-H. (2010). Coverage and Framing of Racial and Ethnic Health Disparities in US Newspapers, 1996–2005. American Journal of Public Health , 224-231. Schneider, E. C., Cleary, P. D., Zaslavsky, A. M., & Epstein, A. M. (2001). Racial Disparity in Influenza Vaccination: Does Managed Care Narrow the Gap Between African Americans and Whites? The Journal of American Medical Association , 1455-1460. U.S Department of Health and Human Services. (2009, October 21). African American Profile. Retrieved Decemeber 20, 2010, from U.S HHS Department of Minority Health: http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=51 U.S. Department of Health and Human Services. (2010, November 11). Heart Disease and African Americans. Retrieved December 22, 2010, from U.S. Department of Health and Human Services: Office of Minority Health: http://minorityhealth.hhs.gov/templates/content.aspx?lvl=2&lvlID=51&ID=3018 Read More