How can we address the health disparities faced by minority populations within our community?

Any community seeking to better serve the health needs of its minority citizens must first determine who, or what, are actually its minority populations. Though the term minority is commonly used to refer to racially designated groups, such as African-American, Latino, Native American Indian, or Asian populations, when it comes to health care, minority populations may also be need-based or grouped by socio-demographic denominators. Thus, a community’s list of “minorities” might include such populations as migrant farmworkers, the handicapped, members of an Amish (or other religious order) neighborhood, the aged, the rural poor or low-income pregnant women.

Taken as a whole, these “special needs” populations can create a profound ripple effect upon an area’s health services continuum, and it is important for each community to carefully consider its minority populations’ health status without bias.

What are some of the needs of minority populations? Research has shown that minority populations have less access to health care providers and receive fewer medical services. And rural minorities are more disadvantaged than their urban counterparts, especially when poverty levels, transportation obstacles and underinsured or uninsured issues are taken into account. In overall terms, barriers to parity in primary health care for minorities fall into the basic categories of inaccessible or unavailable services, patient under-utilization of services that are available and culturally insensitive service delivery.

Department of Health and Human Services statistics reveal the extent of disparities in major minority populations. For example, African Americans face a much higher risk of dying from all major diseases than Caucasians. They are nearly twice as likely to die of a stroke, 40 percent more likely to die of heart disease, 35 percent more likely to die of cancer and 27 percent more likely to die of lung cancer. African Americans are 70 percent more likely to suffer from diabetes and 30 to 40 percent more likely to suffer from hypertension. Black men are hit with prostate cancer 1.5 times more often than white men and though African American women are less likely than white women to be diagnosed with breast cancer, they are more likely to die from it.

The Hispanic population in Texas has surged over 30 percent in the past decade, emphasizing the need for bilingual caregivers and strategies that address the primary health needs of the high proportion of Hispanic families who are uninsured or underinsured. Research has shown that Latinos as a group are more disadvantaged in terms of health insurance coverage than any other minority population.

Although the United States has posted a decline in the rate of infant mortality over the past several decades, substantial differences still exist between subgroups of the population, notably African Americans and Hispanics. Of the other priorities of Healthy People 2010, i.e., cancer screening and management, cardiovascular disease, diabetes, HIV infection and child and adult immunizations, it is always a challenge for researchers and community health workers to understand just how such socio-demographic variables as marital status, generational poverty (itself a leading indicator of nutritional or dietary deficiencies), rural vs. urban location, the structure of family life and the impact of religion affect minority health outcomes in these areas.

Strategies for improving minority health in a community vary. One approach is helping physicians and other caregivers learn to respond effectively to the special or unique needs of minority populations under their care. Until recently, medical schools have not emphasized cultural competence, or the appreciation of societal diversity and how these can impact health care, in their curricula. And, for the past four years for example, African American, Hispanic, Native American, Asian and Puerto Rican students have comprised only six to10 percent of graduating classes in U.S. medical schools, figures that do not match population ratios. Training programs in cultural competence for health caregivers, organizations and administrators are becoming more widely available and emphasized.

Communities can adopt a long-term view toward easing this disparity by encouraging and supporting their minority youth in choosing a health-related career.

Providing National Health Service Corps (NHSC) scholarships to underrepresented minorities has been an important federally-funded method to increase numbers of minority physicians, but state or private funding sources are also available.

Other types of programmatic assistance funded by the Federal government are available to areas designated as medically underserved or suffering from a shortage of health care providers. Counties in Texas designated as a Health Professional Shortage Area (HPSA) and/or a Medically Underserved Area (MUA) and/or a Medically Underserved Population (MUP) are eligible for certain types of funding, including minority health resources. [The current HPSA/MUA status of any county in Texas can be checked online at the Texas Department of State Health Services’ Health Professions Resource Center (HPRC) at http://www.dshs.state.tx.us/chs or by calling (512) 458-7261, or Toll Free in Texas (866) 239-7279. The E-mail address for HPRC information is feedback.opp@tdh.state.tx.us

Communities and hospitals are exploring innovative approaches to bridge the health services gaps found among minority populations, which, statistics prove, are more likely to be poor and underinsured or uninsured, creating barriers to access for services that may be available. Communities, public health agencies and hospital systems are teaming up to experiment with new models of service delivery, including creating health care leadership forums that establish local and regional health care priorities and develop action plans and locating clinics in areas of high need and non-traditional settings, such as churches, senior centers and homeless shelters. Other community interventions include the training of community health workers (promotoras), priest blessings of infant car seats, and providers working with faith-based or traditional healers.

It is in any community’s best interests to institute strategies for creating culturally competent systems of care, which are based on a rationale of changing demographics, to meet the goal of improving quality of services and health outcomes. It is with this vision that a community can enhance the health of its citizens while it meets legislative, regulatory and accreditation mandates, gains a competitive edge in the marketplace and decreases risk of liability/malpractice lawsuits.