Health Disparities: Visions of a New Approach to Health Care

1. Health Disparities: Visions of a New Approach to Health Care Frank McClellan Beck Chair Professor of Law, Co-Director Center of Health Law, Policy and Practice Beasley School of Law at Temple University

2. Seeing Patients: Unconscious Bias in Health Care

3. The Story of Mr. Jackson • History of Heart Disease • Diabetes • High Blood pressure • Heart Attack • Emergency Room Visit • Dies 6 hours later in treatment room • Never seen by cardiologist at hospital

4. Life Expectancy by Race and Gender Source: CDC Vital and Health Statistics Report October 2010, United States Life Tables by Hispanic Origin, http://www.cdc.gov/nchs/data/series/sr_02/sr02_152.pdf - study from 2006

5. Work Life Expectancy by Age, Gender and Race Source: Work Life Estimates at Millennium's End: Changes over the Last Eighteen Years By: James Ciecka, Thomas Donley, and Jerry Goldman; Based on Data from the US Bureau of Labor Statistics (1986) and Ciecka, Donley, and Goldman (1995 and 1999); http://lmi.ides.state.il.us/lmr/worklife.htm

6. Source: CDC, NCHS, Health, United States, 2008, Table 18 http://www.cdc.gov/nchs/data/hus/hus08.pdf

7. Source: National Vital Statistics Report, 56(16), 6/11/08: Deaths: Preliminary Data for 2006, Table 8, p32 http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_16.pdf

8. Source: CDC, NCHS, Health, United States, 2008, Table 42.http://www.cdc.gov/nchs/data/hus/hus08.pdf

9. Health Care Divided: Race and Healing a Nation

10. EMERGENCY ROOM VISITS and ACUTE CARE BASED ON RACIAL DISPARITIES

11. Percentage of persons by race with at least one emergency department visit in a 12 month period (2007) Source: National Center for Health Statistics, Data Brief, May 2010 – Emergency Department Visitors and Visits: Who Used the Emergency Room in 2007? Tamyra Garcia, Amy Bernstein, and Mary Ann Bush

12. Acute Care Visits to Various Providers Source: Where Americans Get Acute Care? Increasingly, It’s Not at Their Doctor’s Office by Stephen R. Pitts, Emily R. Carrier, Eugene C. Rich, Arthur L. Kellerman

13. Average Annual Frequency of Acute Care Visits from 2001-2004 Source: Where Americans Get Acute Care? Increasingly, It’s Not at Their Doctor’s Office by Stephen R. Pitts, Emily R. Carrier, Eugene C. Rich, Arthur L. Kellerman

14. Average Annual Ambulatory Visits by Setting Source: Where Americans Get Acute Care? Increasingly, It’s Not at Their Doctor’s Office by Stephen R. Pitts, Emily R. Carrier, Eugene C. Rich, Arthur L. Kellerman

15. Emergency Department Visits Within 12 Months Among Adults 18 Years and Older by Race/Ethnicity Source: CDC and the National Center for Health Statistics - Health, United States, 2009 Report, Table 89, available at http://www.cdc.gov/nchs/data/hus/hus09.pdf#089

16. PA, MD and IL Hospital Emergency Room Visits Per 1,000 Population 2005-2008 Source: The Kaiser Family Foundation, statehealthfacts.org, Hospital Emergency Room Visits Per 1,000 Population 2005-2008, available at http://www.statehealthfacts.org/comparemaptable.jsp?yr=63&typ=1&ind=388&cat=8&sub=94

17. Freedom Riders: 1961 and the Struggle for Racial Justice

18. Gospel Choirs: Psalms of Survival in an Alien Land Called Home

19. Long Walk to Freedom: The Autobiography of Nelson Mandela

20. Unnatural Causes • Is inequality making us sick? • A four hour documentary exploring racial and socioeconomic inequities in health • California Newsreel • www.unnaturalcauses.org

21. Unnatural Causes: Video Trailer http://www.unnaturalcauses.org/video_clips_detail.php?res_id=80

22. Health DisparitiesCommunities of Colorare Disproportionately Affected

23. What is a “Health Disparity?”Conceptual Issues Inequality Difference in condition, rank Lack of equality as of opportunity, treatment, or status Inequity Unfair and unjust Unnecessary and avoidable

24. “Health Disparity” in Public Health – Operational Definition Quantitative measures: rates, percents, means… The Quantity that separates a group from a reference point on a particular measure of health Calls attention to differences in health between groups regardless of cause Can be measured in absolute or relative terms

25. Populationof the United States by Race & Hispanic Origin: 2008 & Projected 2050 Source: U.S. Census Bureau, 2008 National Population Projections, August 14, 2008http://www.census.gov/Press-Release/www/releases/archives/population/012496.html

26. Racial and Ethnic Minority Populations American Indian/Alaska Native (AI/AN) Asian American Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander (NHOPI)

27. Other Populations By . . . Socio-economic status Geography (urban or rural) Gender Age Disability status Risk status related to sex and gender

34. Source: CDC, MMWR, March 21, 2008 / 57(11);281-285, Trends in TB, US, 2007, Table: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2.htm

35. Source: CDC MMWR, V57, SS2, March 21, 2008, p5. http://www.cdc.gov/mmwr/PDF/ss/ss5702.pdf

45. Landmark: The Inside Story of America’s New Health Care Law and What it Means for Us All

46. Patient Protection and Affordable Care Act of 2010 (PPACA): Advancing Health Equity for Racially and Ethnically Diverse Populations http://www.jointcenter.org/hpi/sites/all/files/PatientProtection_PREP_0.pdf

47. The Lost Art of Healing: Practicing Compassion in Medicine

48. Preventive Services Under the PPACA • SEC. 1001 - Providing Free Preventive Care.  All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance. Effective for health plan years beginning on or after September 23, 2010. • SEC. 4002 - Preventing Disease and Illness.  A new $15 billion Prevention and Public Health Fund will invest in proven prevention and public health programs that can help keep Americans healthy – from smoking cessation to combating obesity.  Funding begins in 2010. • SEC. 4103 - The law provides certain free preventive services, such as annual wellness visits and personalized prevention plans for seniors on Medicare.  Effective January 1, 2011. • SEC. 4106 - Improving Preventive Health Coverage. To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost.  Effective January 1, 2013. Source: Healthcare.gov, http://www.healthcare.gov/law/about/order/byyear.html

49. Interim Final Regulations (IFR) and Preventive Care • Section 1001 of the Affordable Care Act amending section 2713 of the PHS Act, along with a set of interim final regulations (issued by the Internal Revenue Service, DHHS, and the Department of Labor on July 19, 2010 to implement provisions of health care reform) require that a group health plan and a health insurance issuer offering group or individual health insurance coverage provide coverage for the recommended preventive services without cost-sharing requirements for: • Evidence-based items or services that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force (Task Force) with respect to the individual involved. 2. Immunizations for routine use in children, adolescents, and adults that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (Advisory Committee) with respect to the individual involved.

50. IFR and Preventive Care Continued… 3. With respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA). 4. With respect to women, evidence-informed preventive care and screening provided for in comprehensive guidelines supported by HRSA (not otherwise addressed by the recommendations of the Task Force). The Department of HHS is developing these guidelines and expects to issue them no later than August 1, 2011.