# Presentation: 103835

## Eliminating Health Disparities:Challenges and Opportunities

**Marsha Lillie-Blanton, Dr.P.H.**
**Vice President in Health Policy**
**The Henry J. Kaiser Family Foundation**
**Centers for Disease Control and Prevention**
**19th National Conference on Chronic Disease**
**March 3, 2005**
**Atlanta, GA**

## Health Determinants

**Social and Environmental Conditions of Life**
**Family History**
**Health Infrastructure of Local Community**
**Health Coverage and Quality of Care**

**Figure 1**

## Challenges & Opportunities

**Increasing Awareness and Knowledge**
**Assuring Adequate and Meaningful Insurance Coverage**
**Improving Healthcare Quality**

**Figure 2**

## Awareness and Knowledge of Health and Health Care Disparities 

## “How Do You Think the Average African AmericanCompares to the Average White Person in Terms of...?”

- Aware
- of the
- differ-
- ences

**INFANT MORTALITY**

**Whites Say**

- Not aware of the
- differences

**45%**

**54%**

- “just as well off” (39%)
- “better off” (6%)
- “don’t know” (9%)

**African Americans Say**

-  say “worse off”

- Aware
- of the
- differ-
- ences

- Not aware of the
- differences

- say “worse off”

**42%**

**58%**

- Aware
- of the
- differ-
- ences

**LIFE EXPECTANCY**

**Whites Say**

- Not aware of the
- differences

**43%**

**57%**

**African Americans Say**

- say ”worse off”

- Aware
- of the
- differ-
- ences

- Not aware of the
- differences

- say “worse off”

**46%**

**53%**

- say...

**Figure 3**

- say...

- “just as well off” (42%)
- “better off” (8%)
- “don’t know” (8%)

- say...

- say...

- “just as well off” (43%)
- “better off” (5%)
- “don’t know” (9%)

- “just as well off” (36%)
- “better off” (10%)
- “don’t know” (7%)

- SOURCE:  Kaiser Family Foundation Survey of Race, Ethnicity and Medical Care:  Public Perceptions and Experiences, October 1999 (Conducted July - Sept, 1999.

- Facts:  In 1997, black infant mortality was 2 1⁄2 times higher than white (14.2 per 1,000 black infants born versus 6.0 per 1,000 white infants born), and blacks in 1996, on average, lived 6.6 years less than whites.

## Heart Disease Death Rates for Adults 25-64, by Income, Race and Gender, 1979-1989

- NOTE:  These data are the most recently available by race and income.
- SOURCE: Health, United States, 1998, *Socioeconomic Status and Health Chartbook, *Data Table for Figure 27.

- White, Non-Latino

- African American, Non-Latino

- Deaths per 100,000 person years

**Figure 4**

**Under $10, 000**

**Over $15, 000**

## What More Can Be Done To Increase Awareness/Knowledge

**Outreach and informational efforts to  make the facts known**
**Education and training of health providers through professional associations & credentialing organizations**
**Expand Knowledge Base (****Collection and Reporting of Data by Race& Social Class;  Research on Interventions****)**

**Figure 5**

## Insurance Coverage

## People of color are more likely than whites to be uninsured or covered by Medicaid

**White,**
**Non-Latino**
- 165.9 million

**African**
**American, **
**Non-Latino**
- 32.0 million

**Latino**
- 38.2 million

**Asian/**
**Pacific**
**Islander**
- 11.2 million

**American                         Indian/**
**Alaska Native**
- 1.5 million

- NOTE: “Other Public” includes Medicare and military-related coverage.
- SOURCE: Kaiser Commission on Medicaid and the Uninsured, *Health Insurance Coverage in America: 2003 Data Update*, 2004.

**Nonelderly Population 2003**

**Figure 6**

**Two Or                     More Races**
- 3.9 million

**Uninsured        Medicaid and Other Public        Private (Employer and Individual)**

## One-quarter to nearly one-half of nonelderly low-income population groups are uninsured

- NOTE:  Less than 200% of poverty level = $28,256 for family of 3 in 2001.
- SOURCE:  Kaiser Commission on Medicaid and the Uninsured, *Health Insurance Coverage in America: 2001 Data Update, *2003.

- White, Non-Latino
- Latino
- African American, Non-Latino
- Asian/Pacific Islander
- American Indian/Alaska Native

**200%+**

**<200%**

- White, Non-Latino
- Latino
- African American, Non-Latino
- Asian/Pacific Islander
- American Indian/Alaska Native

_**Poverty Level**_

**Figure 7**

## What More Can Be Done To Improve Coverage

**Simplify Medicaid Enrollment and Eligibility Process**
**Improve Medicaid Retention of Enrollees**
**Develop Private Sector Financial Incentives for Low-Wage Workers**
**Build Public Consensus on Viable Approaches**

**Figure 8**

## Improving Quality of Health Care

## Disparities Exist Among Insured Children: Underuse of Medication Among Medicaid Beneficiaries with Asthma

- * Difference is statistically significant after adjustment.
- + Compared to whites
- ‡ Compared to families in which the parent had graduated from high school, but had no additional education
- NOTE:  Model adjusted for socio-demographic factors, symptom level, and reports of processes of care. The children, ages 2-16, were enrolled in managed care plans located in California, Massachusetts, and Washington state.
- SOURCE:  Finkelstein et al., 2002.

**Figure 9**

- Odds Ratio of Underuse Given the Characteristic Below

- ‡

**+**

**+**

## Disparities Exist Among Insured Adults: Reperfusion Therapy in Medicare Beneficiaries with Acute MI

**Men**

**Women**

- Source: Canto, JG et al.  *New England Journal Of Medicine.  *2000 April 13; 342(15):1094-100.

**Figure 10**

## What More Can Be Done To Improve Health Care Quality and Reduce Disparities  

**Collect and Report Data on Patterns of Care By Race**
**Research on Interventions**
**Leadership from Professional Societies in Implementing Practice Guidelines**
**CMS Peer Review/Quality Improvement Activities**
_**Medicaid Specific**_
**Cultural Competence Purchasing Guidelines for MCOs**
**CMS Quality Assurance Requirements for MCOs (42 DFR 438.240)**

**Figure 11**

## What can you do?

**Get to know the evidence**
**Engage colleagues in discussions about observed differential practices **
**Support data collection and analysis efforts in your clinical practice settings**
**Review your own practices to ensure that standards of care are followed across groups**
**Encourage 4T’s: ****talent, technology, trust, tracking**

**Figure 12**

## www.kff.org/whythedifference