Health Disparities Still Problematic

A new policy brief from the Robert Wood Johnson Foundation finds that health care inequities are still a serious problem for many

Health Screening and Disparities Press Conference

Americans, depending upon their race, gender, income, location and other social factors. The report is available for download on the Health Affairs website.

Researchers analyzed more than a decade’s worth of results from studies on health and health care imbalances. They concluded that despite several well-intentioned programs, there is still a long way to go to achieve health equity in many parts of the country. In some cases,the US fares no better than some developing countries.

Gender and race still affect lifespan — with whites outliving African-Americans by 3.8 years on average. The gap in male-female longevity has narrowed, but it’s due to a dramatic increase in female mortality in 42 percent of US counties between 1992 and 1996. Gender and race together widen the disparities gap further — Asian females, on average, live 20 years longer than black, inner-city males. 

When location, income, education, and other social factors were added, evidence is even clearer that those in lower socio-economic tiers had worse health, more chronic diseases, and greater risk of dying than those in more well-to-do areas. The report reminds us that it’s not simply one or two factors which affect health status, but rather a combination of many factors. The goal is to figure out how these different issues interact and to create viable policy solutions to address them.

While this news is disturbing, it’s not particularly surprising. The Institute of Medicine’s 2002 landmark report, Unequal Treatment, Confronting Racial and Ethnic Disparities in Health Care, made similar conclusions 10 years ago. Although numerous policy recommendations were offered to combat health disparities, awareness on the part of policy makers, practitioners, and institutional providers is still low. In the meantime, rising incidence of obesity and type II diabetes, lack of physical exercise, poor access to healthy food choices, lifestyle issues like tobacco use, and lack of regular primary care – often due to lack of insurance – are still major stumbling blocks in many lower-income, minority communities throughout the country.

The Affordable Care Act may address some of these problems, however, researchers concluded there is still a long road ahead to create “healthier neighborhoods,” improve health literacy, provide higher-quality care, and close the disparities gap to achieve a more equitable health system.


Tagged: disparaties, gender, health, Health equity, healthcare, linkedin, race

USPSTF Recommends Annual Lung Screening for High Risk Adults

Adults at high risk of developing lung cancer – especially smokers – should have low-dose CT scans annually, according to new recommendations by the US Preventive Services Task Force. The panel determined that yearly scans “can prevent a substantial number of lung cancer-related deaths,” according to a press release issued today.

Smoking causes some 75 percent of lung cancers. The longer people smoke, the greater the risk of developing lung cancer over time. Most lung cancer occurs in people 55 and older.

After reviewing current data and clinical evidence, the panel determined that anyone with a 30 pack year habit, age 55 to 80, who currently smokes or who has quit within the last 15 years, will benefit from the additional scans. A “30 pack year” is the equivalent of smoking one pack a day for 30 years or two packs per day for 15 years.

“Lung cancer is the leading cause of cancer death in the United States and a devastating diagnosis for more than two hundred thousand people each year,” said Task Force chair Virginia Moyer, M.D., M.P.H.

These recommendations support the results of a recent collaborative review of low dose CT screening by the American Society of Clinical Oncology, the American Cancer Society (ACS), the American College of Chest Physicians (ACCP), and the National Comprehensive Cancer Network (NCCN)as part of clinical practice guidelines.

Nearly 90 percent of people who develop lung cancer die from the disease, in part because it often is not found until it is at an advanced stage. “By screening those at high risk, we can find lung cancer at earlier stages when it is more likely to be treatable,” Moyer said. Continue reading

Health of Americans Ranks Worst Among High-Income Countries

Well, this sure is depressing.

Amid all the news about more Americans gaining health insurance, the to-do over New York City Mayor Bloomberg’s war on super-sized sugary drinks, and efforts to provide healthier school lunches, there’s this:

The U.S. ranks at or near the bottom in nine key areas of health: infant mortality and low birth weight; injuries and homicides; teenage pregnancies and sexually transmitted infections; prevalence of HIV and AIDS; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability, according to a recent report from the National Research Council and Institute of Medicine.

medicines-530x300Researchers said that Americans generally die sooner and have higher rates of disease and injury than people in other high-income countries. This is true across all age ranges from 0-75 and even among those considered more “well off” – with health insurance, higher education levels, higher incomes and healthier lifestyles. Nearly two-thirds of the difference in life expectancy between males in the U.S. and these other countries can be attributed to deaths before age 50.

This is the first time a comprehensive comparison of multiple diseases, injuries, and behaviors across the entire life span between the U.S. and other peer nations has been made. The 16 peer countries in the report include Australia, Canada, Japan, and most western European countries.

“Americans are dying and suffering at rates that we know are unnecessary because people in other high-income countries are living longer lives and enjoying better health. What concerns our panel is why, for decades, we have been slipping behind,” said Steven H. Woolf, professor of family medicine at Virginia Commonwealth University and chair of the committee that wrote the report, in a statement.

American infants, children and teens are disproportionately affected, report authors said. For decades, the U.S. has had the highest infant mortality rate of any high-income country, and has ranked low on premature birth and the proportion of children who live to age 5.  U.S. adolescents have higher rates of death from traffic accidents and homicide, the highest rates of teenage pregnancy, and are more likely to acquire sexually transmitted infections.  Woolfe called these findings “tragic.”

On the positive side, After age 75, Americans live longer than the comparison groups, die less frequently from cancer or stroke, control blood pressure and cholesterol better, and smoke less.

The U.S. consistently spends more per capita on health care than any other Western nation – an average of just over $8,300 in 2010. That’s more than double that of Great Britain, Japan, or New Zealand – countries with universal health coverage. Check out this interactive map to see how the U.S. does against other countries.

Why?

It’s not just one factor, say the researchers. Unhealthy lifestyles, like high-fat diets leading to obesity is one cause. Income disparities, high levels of poverty and lower education levels also contribute to the gap. However, report authors are quick to point out that even when controlling for variables in income, race, and education, the United States still fares far worse than other prosperous nations.

Intense outreach and education about health disparities between the United States and other nations should be a priority, the report concluded. Other recommendations include more diligent efforts to achieve national health objectives and creating a more comprehensive national dialogue about the health status of Americans.

“If we fail to act, the disadvantage will continue to worsen and our children will face shorter lives and greater rates of illness than their peers in other rich nations,” Woolf said.


Conference message to health journalists: be skeptical.

Day One at the Association of Healthcare Journalists conference in Boston and I already feel like a better journalist. Today focused in part on skepticism.

This morning, Marshall Allen of ProPublica helped us make more sense of hospital ratings. When an organization or facility pronounces a “tops in…” or “ranked one of the best in…” stop and ask — how was the data gathered? What are the comparison parameters? Who did the survey? Is it based on anything beyond opinion? Can it be quantified? Or for that matter, even verified? Are they presenting absolute or relative data? Or using a little of each when it suits the promotional purposes?

Then, Ivan Oransky of Reuters Health News and RetractionWatch.com, and Gary Schwitzer, who runs HealthNewsReview.org walked us through how to really understand clinical studies.

Journalists need to look at basic criteria – whether it was a human or animal study, the size of the cohort, how the stats are presented (absolute vs. relative again), whether it was observational, or self-reported data, or whether the math actually adds up.

Also, make sure comparisons are apples to apples: for example, Ivan discussed a recent study citing a statistical association of coffee drinking with cancer. The study compared a group of hospitalized pancreatic cancer patients that happened to be coffee drinkers with a “control” group of non-coffee drinking patients hospitalized for non-cancerous digestive problems. Pancreatic cancer patients may be coffee drinkers, however, those with other disorders may not drink coffee because of their other health problems (like stomach irritation) or other reasons; so if the control group did not have cancer and happened to not drink coffee, is there really a link? It’s not really a valid comparison.

Of course various reporting basics were also emphasized, such as getting comments from experts other than study authors, being wary about outlier claims, not writing about early phase trial drugs as if FDA approval was assured, and making sure to obtain a full copy of the study, not just basing information on the abstract.

Lastly, make sure you understand the scientific jargon so you can simplify it for readers. If you’re not sure, ask. Even if you think it’s a dumb question. Because if you don’t understand the information, chances are good that your readers won’t either.

Our job as health journalists is to make sense of clinical studies for our readers and help them to understand what it means in the context of their lives. The first step is to make sure we understand it ourselves.

Today, a hundred or more journalists learned how.


Just a little heart attack

Before leaving to attend this week’s Association of Health Care Journalists conference, I wanted to share a video from the Go Red for Women campaign.

With no disrespect to the men out there,   women are under enormous stress — juggling career, family, perhaps school or volunteer work too. Our culture expects us, as Sheryl Sandberg said, to Lean In, and just work harder  to get ahead.

Unfortunately most of us don’t have her financial resources at our disposal. So we figure out how to manage, somehow. The thing is, stress has a major impact on our health, including our hearts — and we may not even realize it.

As this video from the Go Red campaign shows,  the warning signs can be powerful.

Take a few minutes each day to de-stress. I’m off to find out how to sharpen my skills as a health journalist.