Health Literacy In Health Care

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Health Literacy In Health Care



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In , blacks trailed whites in women receiving prenatal care in the first trimester 75 vs. In , only Black women were also more likely to report not receiving advice from their prenatal care providers about smoking cessation and alcohol use. There was also less counseling regarding breast-feeding although the difference was not significant in this study [ 44 ]. Looking at the youngest mortalities, black infants have a significantly higher neonatal and post-neonatal mortality than any other ethnic group [ 45 ].

Therefore, the differences in mortality are due to factors which have already made their impact at the time of birth, such as the health status of the parents at conception, genetics, and environment [ 46 ]. Over recent decades, four main causes of morbidity stand out: heart disease, diabetes, cancer, and homicide. The black population displayed a larger decrease in death rates for heart disease, cancer, and HIV disease accounting for the narrowing gaps. Additionally, there was a larger decrease in unintentional injuries in black males. According to the CDC, leading risk factors for heart disease and stroke currently are high blood pressure, high cholesterol, diabetes, current smoking, physical inactivity, and obesity.

Individuals with two or more of these factors are at a higher risk for stroke and heart disease. In , the prevalence of two or more of these factors was highest in African Americans, and heart disease among African Americans has been the first or second cause of Years of Potential Life Lost in the USA ever since these data have been kept. This disparity is not surprising given that African Americans had the highest prevalence of hypertension from —; in —, black men and women aged 20 years and older continued having the highest prevalence of hypertension African American women had the highest prevalence of obesity during this period, and African Americans have had the highest rates of diabetes since the data have been collected.

When looking at all cancers, African Americans were the group most heavily impacted in Incidence rates were highest in the black population Among women, however, the overall incidence rate for cancers is not the highest among ethnic groups, but the death rate is. A health disparity among women is best illustrated by breast cancer. While the incidence rate per , was lower for African American women than for white women and the total population , the death rate was highest among African American women at For African American males, the greatest cancer disparity is prostate cancer. For the period —, the incidence was When reviewing health disparities, homicides are always the cause of death with the largest ethnic disparity.

From the period —, black males died from homicide at ten times the rate of whites. In , the age-adjusted homicide rate for blacks was This figure was three times greater than the rate for any other ethnic group. While black males had the highest rate, black females had a higher rate of homicide deaths than any other females, and intimate partner homicide was a major factor [ 49 ]. Homicide is the absolute measurement of violence, revealing the unquestionable ethnic disparity. However, violence affects African Americans in many other ways. In , higher rates of aggravated assault, child maltreatment, and fights among high school students were reported.

In , African American women reported higher rates of experiencing rape and physical violence by an intimate partner [ 49 ]. National surveys show lower rates of mental disorders for blacks and Hispanics Yet, more blacks suffered serious psychological distress than whites in the previous year 6. That is to say, black people endure more intense and frequent mental and behavioral health issues than their counterparts, at least in part related to poverty and exposure to racism and discrimination, both of which disproportionally affect minorities [ 51 — 53 ].

It has been shown that blacks receive fewer medication due to racial bias, low income, and insurance status. A study showed that blacks with depression and without insurance receive fewer antidepressants than those insured; even among the insured, they received fewer medication than whites [ 54 ]. Another study found that fewer blacks receive opioids at discharge from emergency department visits due to back and abdominal pain, compared to whites [ 55 ]; also, it has been reported that substance abuse treatment centers serving higher percentages of minority populations prescribe fewer selective serotonin reuptake inhibitors SSRIs than centers serving fewer minority clients [ 56 ]. With respect to tobacco, African Americans have lower rates of use than whites.

However, analyses have identified a crossover at age 29, whereby blacks end up with higher rates of tobacco use than whites, largely which were traced back to differences in educational attainment and marital status [ 58 ]. Almost 30 years ago, the CDC concluded a report on racial disparities that reducing tobacco could lead to reducing wide health disparities in the following terms. The reduction of cigarette smoking in the black population is one of the most important, immediately available options for reducing the wide disparities between the health status of minorities and that of whites [ 59 ].

Yet, the research discussed by the Surgeon General on the 50th Anniversary of the first Surgeon General Report on Tobacco showed that blacks continue to suffer a disproportionate burden of tobacco-related mortality and morbidity [ 60 ]. Obviously, much remains to be achieved when it comes to addressing the needs of the poorest communities in America, which are also those who suffer the highest rates of tobacco use and tobacco-related consequences.

Community-Based Participatory Research CBPR is a promising approach to help overcome the lack of adequate smoking cessation programs for minority and underserved populations, such as the implementation of community-based smoking cessation interventions that are peer-based and place emphasis on behavioral change training and social support, along with the use of nicotine replacement therapies and strategies toward stress management [ 61 ].

These and other efforts take advantage of federal and state-funded quit-lines that offer free counseling and nicotine replacement therapy to those interested in quitting tobacco. However, it is also necessary to acknowledge that the high cost of effective medications has been an important barrier to quitting tobacco among blacks and other minority groups. The situation regarding drug use such as marijuana and cocaine is no different.

Blacks have a slightly higher rate of past-month use of marijuana as compared to whites Whites and blacks have similar rates of past-month use of cocaine 0. However, the consequences of drug use disproportionally affect blacks. Only one third to one fourth of people in need of addictions treatment got it, at least as reflected in the latest national survey of drug use.

The impact of substance use and mental health problems is evident in other social domains. For example, in , there were , arrests due to marijuana possession Blacks were almost four times more likely than whites to be arrested for marijuana, in spite of the fact that both groups have relatively similar use rates as shown earlier [ 62 ]. About two out of three people with any mental illness also had alcohol or drug dependence Overall, While we cannot break down these data to analyze possible racial and ethnic differences, it is important to also consider that stigma has been major factor in blacks not receiving mental health care and may further complicate the effect of other healthcare barriers [ 63 — 66 ].

In sum, the data depict a rather complex picture in which blacks generally have similar if not lower incidence rates of mental disorders and substance involvement than whites, but at the same time suffer higher prevalence of serious mental health and legal problems, with devastating effects. The difference between lower incidence and higher prevalence derives from longer duration, given lower access and utilization of healthcare services, lower quality of healthcare services, and worse complications of comorbidities for minority and underserved populations, among others [ 56 , 67 — 72 ].

In convergence, the greater impact of mental health problems for blacks stems from structural factors that include poverty, racism and discrimination, and culture [ 73 — 75 ], such that the stress caused by the interaction of poverty, inequality, and discrimination affects blacks above and beyond of the effect on other non-minority populations. Clearly, several barriers need to be lifted if we are to make progress in this area, beginning by providing expanded true access to healthcare services including transportation, availability of culturally friendly services, and the establishment of mechanisms that will avoid stigmatizing clients and ensure confidentiality of the data [ 51 ]. In this section, we review the social response to health needs of blacks, as implemented through policies and programs, as well as issues of access and utilization.

The role of an educated and culturally sensitive workforce is highlighted. The attitude expectations and behaviors of providers and patients were examined. Conscious and unconscious differences in treatment based on ethnicity, socioeconomic status, and gender were reviewed. This document reviewed the biases, stereotypes, and communication obstacles impacting the interaction of providers and patients and their utilization of the healthcare system. Findings in the study concluded that:. In recent years, blacks have had worse access to care than whites for about half of access measures used. During the first half of , the percentage of adults ages 18—64 without health insurance decreased more quickly among blacks and Hispanics than whites, but differences in insurance rates between groups remained.

This plan aims to increase healthcare protection by expanding coverage, holding insurance companies accountable, decreasing healthcare costs, allowing provider choice, and enhancing the quality of care [ 78 ]. About eight million African Americans obtained access to expanded preventive services, and nearly eight million African Americans with a preexisting health condition became able to obtain coverage.

Since the first quarter of , the uninsured rate dropped by 9. Approximately 5. The ACA is changing the funding of hospitals from a system based on quantity of patients and procedures to one focused on quality of care—value instead of volume. This change in the basic protocol of healthcare delivery in the USA offers a significant opportunity for African Americans and other under-represented and minority groups to insert themselves into the health care infrastructure [ 81 ].

However, not all states have undergone Medicaid expansion under the ACA, with negative consequences for access and the health status of minorities and the poor. Texas and Mississippi—states with higher percentages of black populations—are among the 17 that have rejected Medicaid expansion [ 82 ]. Also, a study showed that, in states not expanding Medicare, low income adults aged 18—64 were more likely to be black and reside in rural areas than in states expanding Medicare; also, they were less likely to have a usual source of care and use preventive services dental checkups, routing checks, flu vaccinations, and blood pressure checks [ 84 ].

An educated and informed black population will use health care services more effectively. Forty percent of African Americans have limited reading skills [ 85 ]. This skill is necessary to make appropriate health decisions. Good health literacy requires the reading, analysis, and decision-making skills to make appropriate health decisions. Lack of health literacy skills is considered a cause of health disparities, and disparities by both race and educational status when health literacy are taken into account [ 86 ]. People with poor health literacy have problems communicating with their health providers, reading instructions on medicines, and completing medical and insurance forms. In , blacks were In the present, only 5. As we look more broadly at clinical providers, we see that only 5.

Facing the increasing need for health professionals, there has been a significant expansion of health training programs across the USA. It is stunning to see that health programs in HBCUs have not shared in this growth. This section presents the key messages the authors would like to convey regarding social determinants of health and health disparities, health needs, and healthcare policy and services, to improve the health of African Americans in the USA. Given all that has been detailed, it is obvious that there is much to be done if we are ever to achieve health equity or eliminate health disparities in the USA and assure good health to the African American population.

It was not achieved for African American people [ 89 ]. The current picture is clear; the greatest health disparity between the total US population and any ethnic group is found in African Americans. As stated in the introduction, racism may be the most important phenomenon underlying black health disparities, exerting its ominous effects through institutionalized, systematic stigma and exclusion. As we have shown, health disparities for blacks are racial disparities; social and gender disparities are interwoven and magnified to render blacks the least healthy of all groups.

Historically structured racist practices and institutions are further reproduced by white-majority policymakers, decision makers, administrators, educators, and healthcare providers. At the individual level, this focus is translated into insufficient allocation of resources to black communities and populations [ 90 ]. Poverty, low education, unemployment, violence, insecurity, and environmental exposures contribute to poor reproductive health and birth outcomes among black women [ 90 ]. These factors affect the woman and her family at multiple levels: low access to healthy foods, inadequate access to preventive and antenatal healthcare, intimate partner violence [ 91 ], distrust of the justice and police system [ 92 ], unhealthy behaviors, substance abuse [ 93 ], and stress [ 94 ].

A greater proportion of black children are born and live in this social, environmental, and culturally deprived environment; thus, they grow and develop unequally—socially, psychologically, and healthwise, throughout the lifespan [ 95 ]. Research into minority and black health issues has been found to be both insufficient and biased [ 96 ]. The systemic nature of racism as a cause of health disparities must be counteracted by equally systemic measures, through social programs, economic investment, criminal system reform, decreased segregation in positions of institutional power, more inclusive research and appropriate funding of public agencies, healthcare institutions, and HBCUs [ 90 , 97 ].

Further implementation and expansion of the Affordable Care Act should result in improved health outcomes for black populations [ 98 ]. Of course, addressing the wide ranging consequences of poverty is a social problem that all those working for health equity must attempt to redress. Although there has been significant progress in assuring healthcare for the poor with the ACA and other programs, health institutions must not pretend that adequate healthcare is available to all. The care that is provided to all must be of the highest quality, not only technically but ethically. Physicians and public health professionals, black and otherwise, must stand for racial and social justice [ 99 ].

Proactive efforts must be taken throughout health systems to eliminate the conscious and unconscious differences in the quality of care currently provided in all aspects of medical practice. These efforts must be directed at the practice of all health providers and the functioning of all systems [ ]. Public health should take the lead in advocating for and providing the expertise to assure that inadequacies in physical and social environments do not harm African American populations. In the physical environment, priorities include informing at-risk populations of the impacts of their unhealthy environments, assurance of good housing and transportation, and documenting the location and impact of toxic waste; these interventions should be approached through cross-sector collaborations [ ].

The health of persons under the control of judicial and incarceration systems may be one of the highest priorities in the social arena. A concentrated effort to educate and train justice system administrators and staff in the basic principles of health care is necessary, and the provision of health services should be overseen by an unbiased body which is independent of the justice system. It has been demonstrated that healthcare systems based outside prison walls can provide excellent healthcare to inmates and eliminate the barriers which prevent returning convicts from receiving appropriate care upon release [ ]. Addressing the problems of nutrition and food deserts should be high priorities. Diabetes, CVD, and obesity will be directly affected, while many other major health problems in the African American community will be impacted [ , ].

Many other disparities contribute to the poor health status of African Americans. The same can be said for substance abuse, lung cancer, and stroke. African Americans are over-represented when the top 10 causes of Years of Potential Life Lost are documented. Mental illness is a major problem, but much work needs to be done to develop an accurate and useful picture of the overall disparity [ ]. Access to preventive, curative, and rehabilitative care must be assured to all persons including African Americans.

Access is a lifelong need. Care for the potentially pregnant women is crucial and may have long-term consequences for her and her offspring. Comprehensive care for the infant, child, and adolescent is the key to their lifelong health and also their ability to function as productive and creative people. Adults often must be reminded that there are standards for healthcare from which they will benefit, and, as the population ages, access to appropriate and comprehensive care must be assured for elderly African Americans.

In order to assure care of the highest quality, proactive efforts must be taken throughout health systems to eliminate the conscious and unconscious differences in quality of care provided. These efforts must be directed at the practice of all health providers and all systems. Today, the differences are integral to virtually all health practice [ ]. Education at all levels may be the most important role of health professionals.

It is our responsibility to translate our knowledge of health into the language and culture of the client we are serving. Minorities are more likely to seek care from healthcare professionals of their own ethnicity. Communities are more than willing to collaborate with providers in taking on this task [ ]. The development of health policy is most often the responsibility of those with no health expertise, with little representation of the black population. Without the education of health professionals who are knowledgeable of the culture of African American communities and committed to their well-being, the future of policy development is bleak [ ].

HBCUs have played a major role in a variety of fields in the years of their existence and are not being appropriately utilized in the training of black health professionals. Also, the policies of health practice and health institutions that serve African Americans are most often determined by public and private sector leaders who have no health training. It is the responsibility of trained health professionals to provide the information needed to make appropriate health policy decisions and to evaluate their implementation. In addition to these factors, communities, providers, and individuals must all understand that politics is a key factor in the ongoing battle to eliminate the disparities in health outcomes in the USA that are based on racial differences.

After years of social segregation and discrimination, current health data confirm that African Americans are the least healthy ethnic group in the USA. Although the resources and policies to eliminate disparities exist in the USA, there has been inadequate long-term commitment to successful strategies and to the funding necessary to achieve health equity. African Americans have not been in the fiscal nor political positions to assure the successful implementation of long-term efforts; the health of African Americans has not been a priority for decision makers. Usually, the black community is not present when strategies and programs addressing their poor health status are designed and prioritized, and planners have limited understanding of the social mores and history of the African American community.

The administration of health and social organizations serving black communities is rarely in the hands of those with this knowledge and commitment. Current mortality disparities are evident in cardiovascular disease, cancer, diabetes, and infant mortality. These causes of death may be the most visible health problems for African Americans, but they do not tell the whole story. Mental illness is the second largest cause of morbidity in African Americans, and violence in the form of homicide is the greatest cause of preventable death. High levels of poverty, lack of education, and excess incarceration further compound the poor health status of African Americans.

The USA is in the midst of a surge in training health professionals, but, for many reasons, the institutions HBCUs created to educate African Americans have not made much impact on advancing the health of African Americans. African Americans are under-represented in all of the professions responsible for the provision of intimate physical, mental, and social care. All health providers should be required to obtain regular training and refreshing in the provision of equitable care; this includes providers of color. Training of young people of color in the health professions should be viewed as an urgent national objective requiring the rebuilding of many of social development and community health programs of the past which have been virtually extinguished by lack of funds.

Outreach to young people of color encouraging them to pursue health careers should be given a much higher priority. The role of HBCUs in the preparation of young populations for health careers must be strengthened. It is evident that focusing on health risks alone is not conducive to redressing health disparities among African Americans, given that structural factors primarily underlie their poorer health outcomes and shorter lifespans. Tackling the social determinants of health, from poverty to the built environment, racial discrimination, violence, and incarceration, is likely to elicit greater effects on black health than risk reduction programs.

Even though the ACA has expanded access to African Americans, medical care for people with unhealthy lifestyles and social and cultural barriers to access will have limited effects on reducing health disparities of African Americans in the USA. Superfund sites are hazardous waste cleanup sites managed by the US Environmental Protection Agency since the early s. They pose potential threats to human health and the environment. Dublin L. The health of the Negro. Article Google Scholar. Mortality in the Atlantic slave trade. J Interdiscip Hist. Transoceanic mortality: the slave trade in comparative perspective.

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Baltimore, MD; February Rockville, MD: U. Racial-ethnic disparities in use of antidepressants in private coverage: implications for the Affordable Care Act. Even though residential segregation is noted in all minority groups, blacks tend to be segregated regardless of income level when compared to Latinos and Asians. Individuals that reported discrimination have been shown to have an increase risk of hypertension in addition to other physiological stress related affects.

Individuals living in rural areas, especially poor rural areas, have access to fewer health care resources. Although 20 percent of the U. Individuals in rural areas typically must travel longer distances for care, experience long waiting times at clinics, or are unable to obtain the necessary health care they need in a timely manner. Rural areas characterized by a largely Hispanic population average 5. Financial barriers to access, including lack of health insurance, are also common among the urban poor. The main types of health insurance in the United States includes taxpayer-funded health insurance and private health insurance. There are many issues due to health insurance that affect health equity, including the following:. In many countries, dental healthcare is less accessible than other kinds of healthcare.

In Western countries, dental healthcare providers are present, and private or public healthcare systems typically facilitate access. However, access remains limited for marginalized groups such as the homeless, racial minorities, and those who are homebound or disabled. In Central and Eastern Europe, the privatization of dental healthcare has resulted in a shortage of affordable options for lower-income people. In Eastern Europe, school-age children formerly had access through school programs, but these have been discontinued. Therefore, many children no longer have access to care. Access to services and the breadth of services provided is greatly reduced in developing regions.

Such services may be limited to emergency care and pain relief, neglecting preventative or restorative services. Regions like Africa, Asia, and Latin America do not have enough dental health professionals to meet the needs of the populace. In Africa, for example, there is only one dentist for every , people, compared to industrialized countries which average one dentist per 2, people. The patient provider relationship is dependent on the ability of both individuals to effectively communicate.

Language and culture both play a significant role in communication during a medical visit. Among the patient population, minorities face greater difficulty in communicating with their physicians. Language plays a pivotal role in communication and efforts need to be taken to ensure excellent communication between patient and provider. Among limited English proficient patients in the United States, the linguistic barrier is even greater. Less than half of non-English speakers who say they need an interpreter during clinical visits report having one.

The absence of interpreters during a clinical visit adds to the communication barrier. Furthermore, inability of providers to communicate with limited English proficient patients leads to more diagnostic procedures, more invasive procedures, and over prescribing of medications. This has been helpful when providers do not speak the same language as the patient. However, there is mounting evidence that patients need to communicate with a language concordant physician not simply an interpreter to receive the best medical care, bond with the physician, and be satisfied with the care experience. Spanish-speaking patient with an English-speaking physician may also lead to greater medical expenditures and thus higher costs to the organization.

Provider discrimination occurs when health care providers either unconsciously or consciously treat certain racial and ethnic patients differently from other patients. Two types of stereotypes may be involved, automatic stereotypes or goal modified stereotypes. Critics question this research and say further studies are needed to determine how doctors and patients make their treatment decisions. Others argue that certain diseases cluster by ethnicity and that clinical decision making does not always reflect these differences. According to the National Healthcare Disparities Report, uninsured Americans are less likely to receive preventive services in health care.

Furthermore, limited English proficient patients are also less likely to receive preventive health services such as mammograms. There are a multitude of strategies for achieving health equity and reducing disparities outlined in scholarly texts, some examples include:. Health inequality is the term used in a number of countries to refer to those instances whereby the health of two demographic groups not necessarily ethnic or racial groups differs despite comparative access to health care services.

Such examples include higher rates of morbidity and mortality for those in lower occupational classes than those in higher occupational classes, and the increased likelihood of those from ethnic minorities being diagnosed with a mental health disorder. In Canada , the issue was brought to public attention by the LaLonde report. In UK , the Black Report was produced in to highlight inequalities. Marmot described his findings as illustrating a "social gradient in health": the life expectancy for the poorest is seven years shorter than for the most wealthy, and the poor are more likely to have a disability.

In its report on this study, The Economist argued that the material causes of this contextual health inequality include unhealthful lifestyles - smoking remains more common, and obesity is increasing fastest, amongst the poor in Britain. Under the coordination of the Italian Institute of Public Health , the Joint Action aims to achieve greater equity in health in Europe across all social groups while reducing the inter-country heterogeneity in tackling health inequalities.

Poor health outcomes appear to be an effect of economic inequality across a population. On an international level, there is a positive correlation between developed countries with high economic equality and longevity. This is unrelated to average income per capita in wealthy nations. The United States shows exceptionally low health outcomes for a developed country, despite having the highest national healthcare expenditure in the world. The US ranks 31st in life expectancy. Americans have a lower life expectancy than their European counterparts, even when factors such as race, income, diet, smoking, and education are controlled for. Relative inequality negatively affects health on an international, national, and institutional levels.

The patterns seen internationally hold true between more and less economically equal states in the United States. The patterns seen internationally hold true between more and less economically equal states in the United States, that is, more equal states show more desirable health outcomes. Importantly, inequality can have a negative health impact on members of lower echelons of institutions. The Whitehall I and II studies looked at the rates of cardiovascular disease and other health risks in British civil servants and found that, even when lifestyle factors were controlled for, members of lower status in the institution showed increased mortality and morbidity on a sliding downward scale from their higher status counterparts. The negative aspects of inequality are spread across the population.

For example, when comparing the United States a more unequal nation to England a less unequal nation , the US shows higher rates of diabetes, hypertension, cancer, lung disease, and heart disease across all income levels. Historically, results from studies do not include underrepresented communities and races. Bonham Jr. From Wikipedia, the free encyclopedia. Study causes of differences in the quality of health and health care. The examples and perspective in this article may not represent a worldwide view of the subject. You may improve this article , discuss the issue on the talk page , or create a new article , as appropriate.

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Consolidating this fragmented approach and ensuring that Teen Driving Research Paper is measuring the aspects of care Health Literacy In Health Care Methanol Lab Report in Possibles Metaphors About Water health literacy, language Teen Driving Research Paper, and Human Trafficking Issues competency is critical to Hazan And Shavers Attachment Theory an appropriate standard of care to all Americans. Following a year-long operation by undercover FBI agents, a Maryland Essay About My Writing Process has been arrested and charged with attempting to sell US nuclear secrets. Related Report. Each Hazan And Shavers Attachment Theory has developed via differing histories that emphasize different aspects of care and with patient subgroups and goals that Teen Driving Research Paper not or do not overlap.