Term Paper on "Reducing Health Disparities Among African-American Women"

Term Paper 13 pages (3600 words) Sources: 1+

[EXCERPT] . . . .

Reducing Health Disparities among African-American Women with Metabolic Syndrome

In the past few years, the increasing number of health disparities among African-American women, specifically those ages 35 to 50 with metabolic syndrome, have raised concern and awareness among health care organizations, policy makers and citizens alike. Racial and ethnic minorities experience higher rates of a variety of health concerns than other populations. Research indicates that just a few years ago, nearly 8% of whites were considered to be in fair or poor health compared to nearly 13% of Hispanics / Latinos, nearly 14% of African-Americans and more than 17% of Native Americans. The proposed research project targets this severe problem affecting women in the African-American community. The specific community to be studied involves African-American women affected by metabolic syndrome, including diabetes and hypertension, residing in Montgomery County, Maryland. The study will examine the current use of technology to promote physical activity among this population and suggest future uses of technology to reduce health disparities.

Defining Health Disparities in the African-American Women Population

Other health disparities among African-American women include a doubled amount of infant death rates than that of whites, a 30% higher cancer death rate among African-Americans than whites, and a higher death rate from breast cancer than white women and Vietnamese. In addition, African-American women have a cervical cancer rate that is nearly five times the rate for white women, and the death rate for HIV / AIDS for African-Americans is more than seven times that for whites. Research indicates that there are several potential reasons for such ethnic and racial health disparities. A prominent reason is that even when racial or ethnic minorities are insured at levels comparable to whites, they tend to receive a lower quality of health care for the same health conditions. Research also indicates that African-American patients are less intelligent, less educated, and more likely to abuse drugs, alcohol and more likely to fail to comply with medical advice. African-Americans face reduces access to care, as they are nearly one and a half times more likely to be denied authorization through their managed care system for care after an emergency room visit than whites.

Trends of increased overweight prevalence in children reflect an accelerated gradient in black and Mexican-American children as compared with white children.

Substantial cultural heterogeneity also exists within each aggregate minority population. Within all populations, obesity prevalence varies by region, socioeconomic status, and other demographic variables. Attitudes about obesity also vary across cultures, as where thinness is associated with extreme poverty, deprivation, or wasting diseases, obesity may be viewed as a symbol of social stature, prosperity, and robustness.17

State-Wide Research on Health Disparities

The role of obesity in predisposing individuals to diabetes, hypertension, and other aspects of cardiovascular disease is well established, and obesity contributes to racial/ethnic disparities in cardiovascular disease risk. A gradient of increasing risk of diabetes, hypertension, and coronary heart disease with increasing body mass index levels can be readily demonstrated in several available data sets for blacks, and some related data also are available for other racial/ethnic groups. In particular, obesity has been identified as a contributor to the excess prevalence of diabetes in minority populations. Benefits of weight loss for reducing hypertension-related risks have been reported for black patients in several clinical trials. Weight gain and retention in association with pregnancy have also been identified as risk factors for obesity in black women.

Other potential causes can be found in macrosocietal changes that accompany economic and nutrition transitions, characteristics of local environments that constrain individual choices with respect to eating and physical activity, and sociocultural influences on lifestyle behaviors related to weight gain and weight control. Research indicates that some of these factors may exert their effects early in life, such as during gestation or in infancy, through maternal weight status, or in parental feeding behaviors.

The serious limitations of current approaches to obesity treatment and particularly the apparent less-than-average success of treatment approaches in racial and ethnic minority populations reveal a need to reduce health disparities.

Metabolic syndrome, also known as the insulin-resistance syndrome, refers to a specific clustering of cardiovascular risk factors in the same individual, including abdominal obesity, elevated blood pressure, and insulin resistance. Patients with the metabolic syndrome are at increased risk for developing diabetes and cardiovascular disease. According to a recent analysis of data from the Third National Health and Nutrition Examination Survey, 23. 7% of Americans have the metabolic syndrome. African-American women had a 57% higher prevalence for the syndrome than did black men, who had the lowest prevalence in this study. As a result of the close relationship of obesity to the metabolic syndrome, the rising prevalence of obesity in the United States is cause for particular concern.

Management of the metabolic syndrome consists primarily of 2 strategies: modification or reversal of the root causes, including weight reduction and increased physical activity, and direct treatment of the metabolic risk factors. All of the components of the metabolic syndrome may be improved with weight reduction and increased physical activity. Treatment of several of the individual risk factors associated with the metabolic syndrome has been shown to decrease cardiovascular disease risk, although no randomized clinical trials are yet available to show a decrease in clinical events or increased survival following treatment of the metabolic syndrome.

Importantly, recognition, diagnosis, and treatment of the metabolic syndrome have the potential to contribute importantly to the reduction of health disparities. Research indicates that although data on other racial and ethnic minorities is limited, the high morbidity and mortality rates from cardiovascular disease in African-Americans can be explained in part by the high prevalence and severity of modifiable risk factors. Thus, patients who are at high risk for the metabolic syndrome, such as those with multiple risk factors, should be targeted for intensive risk-reduction measures.

As a result, reduction in racial and ethnic health disparities requires targeting for vigorous prevention and risk-reduction measures.

Health Disparities in Montgomery County, Maryland

Montgomery County, Maryland is a county that represents an increased population of health disparities among African-American women. In the past few years, the Montgomery County Department of Health and Human Services attempted to increase awareness of the disparity in infant mortality between African-American and other County residents. The community identified reducing African-American infant mortality as a priority and established the African-American Health Initiative to work toward eliminating the disparity in infant mortality as well as other health status disparities. Other Montgomery County focus areas include increasing access to care for low-income, uninsured residents; reducing substance abuse, reducing family violence by providing support to high-risk families, reducing asthma hospitalizations among minority children, reducing incidence and complications of diabetes among African-Americans and increasing access to health care.

Infant mortality, or deaths occurring any time between the date of birth and the first birthday, is a cause of concern that illustrates the health disparity in Montgomery County, Maryland. Deaths occurring between 29 days and one year of age are due to a wider variety of causes, including Sudden Infant Death Syndrome and infection, in addition to the causes of neonatal mortality. From 1990 to 1998, the infant mortality rate among African-Americans in Montgomery County was about four times greater than among white infants. In addition, the County's African-American infant mortality rate has frequently exceeded the statewide rate. Access to care, or lack of prenatal care is strongly associated with an increased risk for low birth weight infants, preterm delivery, and maternal and infant mortality.

Montgomery County, through a partnership with Holy Cross Hospital, provides prenatal care for low-income, uninsured women not eligible for Medical Assistance. A smaller percentage of African-American women in Montgomery County, entered prenatal care in the first trimester compared to white women. These problems in infant mortality are a variety of causes, many of which are preventable, such as infection, inadequate prenatal care and poor nutrition. Excluding teenagers, a larger percentage of African-American women in all age groups had low birth weight babies compared to white women in Montgomery County.

The Use of Shared Decision Making to Reduce Health Disparities

Research indicates that shared decision making is an important aspect of making a difference in health disparities among African-American women. It is also clear that interventions to improve access to medical care and reduce behavioral risks must be combined with broader efforts to increase socioeconomic status and reduce racial and ethnic discrimination in eliminating health disparities. Shared decision making could be promoted through collaboration and increased communication among local public health departments, state and local government officials, non-government agencies and organizations, such as voluntary agencies, community-based organizations and philanthropic groups. Additionally, valid, available, and reliable health data must be available on each population category.

Furthermore, African-American community members must be able to design strategies and activities relevant to their cultures, traditions, customs, and beliefs. It should be a priority to promote health and prevent health problems before risks are apparent and problems occur. Community-determined, culturally-relevant strategies that enhance, promote, and improve the health status of communities… READ MORE

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