Published on January 10, 2008
“Implementing Solutions to Health Care Disparities in New York City”Daniel Laroche MDPresident, Empire State Medical Association,NYS National Medical Association affiliateAssistant Professor OphthalmologyNew York Medical CollegeNew York Eye and Ear InfirmaryPresident, Advanced Eyecare of New York: “Implementing Solutions to Health Care Disparities in New York City” Daniel Laroche MD President, Empire State Medical Association, NYS National Medical Association affiliate Assistant Professor Ophthalmology New York Medical College New York Eye and Ear Infirmary President, Advanced Eyecare of New York Legacy: Legacy For over a century, The National Medical Association has boldly shaped the conscience, of American medicine. ESMA NYS affiliate of NMA OVERVIEW: ESMA NYS affiliate of NMA OVERVIEW Non-profit association of African American physicians! Six geographical regions in US 100 local societies 26 scientific sections representing every specialty in medicine. New York Affiliates under ESMA include: Manhattan Central Medical Society Queens Clinical Society Provident Medical Society-Brooklyn Arthur Risbrook Medical Society- Eastern Long Island Strategic Goals 1: Strategic Goals 1 Goal 1: Health and Wellness: Promote optimal health and quality of life for patients and their communities. Strategy 1: Increase community education and awareness through innovative outreach efforts at all levels of the ESMA. Strategy 2: Advocate for the health needs of people of African descent and the medically underserved. Strategy 3: Advance scientific research and clinical knowledge to identify and facilitate new directions in medicine. Strategic Goals 2: Strategic Goals 2 Goal 2: Addressing Health Disparities by dedicating expertise and resources towards eliminating health care disparities. Strategy 1: Prioritize key health initiatives upon which the Association can build a platform to educate its members, the general public, and key policy makers. Strategy 2: Develop strategic alliances with other organizations. Strategy 3: Facilitate and increase in the representation of people of African descent and other underrepresented groups in medicine. Strategy 4: Take an active role in addressing health policy issues that affect patients of African descent. Strategic Goals 3: Strategic Goals 3 Goal 3: Physician Viability: Protect the health and viability of physicians of African descent and their practices to ensure community needs are effectively identified, voiced, and addressed. Strategy 1: Provide a mechanism for physicians to receive assistance in addressing ethical and fair treatment issues. Strategy 2: Provide student and physician members with appropriate updates and Continuing Medical Education (CME) in clinical practice management. Strategy 3: Mentor and nurture and professional development of student and physician members. Strategy 4: Take an active role in addressing health policy issues that affect physicians of African descent. Some Progress has been made: Some Progress has been made The number of Black physicians increased from 909 in 1890 to over 25,000 in 2004. However, the Black physician/patient ratio is only 1/3,000 Vs the White physician/patient ratio= 1/700 However, today in 2006, African Americans continue to suffer far more illness and death than whites Cardiovascular Disease: Cardiovascular Disease Blacks in NY are 55% more likely to die of heart disease compared to whites at ages 45-54 Cancer: Cancer Black New Yorkers are 46% more likely to die from cancer than whites ages 45-54 Gregory Hines Famous Tap Dancer Died of liver cancer At age 57 Ben Carson Famous Neurosurgeon Survived Prostate Cancer Diabetes: Diabetes In NY, 20% blacks suffer from diabetes Results in serious complications including blindness, kidney disease, and amputations Rick James, 56 died from complications related to diabetes Obesity: Obesity 50% of Black women are obese Increases children risks for hypertension, heart disease, diabetes, and cancer AIDS: AIDS 50% of AIDS-related deaths in the city occur among blacks, who account for 25% of the city's population. In addition, black women account for 34% of the city's new AIDS cases Approximately one in five black men ages 40 to 49 living in the city is HIV-positive Statewide, girls and women account for 48% of new HIV cases among people ages 13 to 19, and HIV prevalence among black women is more than 27 times higher than prevalence among white women New York City Department of Health and Mental Hygiene ASTHMA: ASTHMA Black and Hispanic New Yorkers are more than twice as likely as whites of use the emergency care for Asthma In NY, children in poorer neighborhoods are 3x as likely to be hospitalized for asthma than children living in wealthy neighborhoods. Rap star Coolio suffers from Asthma and is a spokesperson For the Asthma and Allergy Foundation GLAUCOMA: GLAUCOMA Leading cause of blindness in the African-American and Afro-carribean community Blacks underwent laser and surgical treatment at half the rate of whites despite increased prevalence Blindness rates from glaucoma are 4-6x higher in Blacks than whites Surgical Undertreatment of Glaucoma in Black Beneficiaries of Medicare: Archives of Ophthalmology Vol 118, Feb 2000 Kirby Puckett had to Retire early from Baseball and loss vision In one eye from glaucoma Ray Charles went Blind from glaucoma At age 6 Infant Mortality: Infant Mortality In NY in 2004, the infant mortality of Black babies is 2-3 x that of whites. Keys to prevention include early and continuous prenatal care Grassroots education in the community Don’t place baby to sleep face down Slide21: Trends in Infant Mortality NYC, 1991-2001 HP 2010 Goal: 4.5 HP 2000 Goal: 7.0 Since 1990 there has been a decline from 16 deaths per 1000 live births to 10 deaths per 1000 live births however disparities continue to exist Lead Poisoning: Lead Poisoning In the year 2000, 6,200 children were identified with lead poisoning, 94% of the children are black This continues to occur despite the fact that the NYC Dept. of Health banned lead based paint greater than 40 years ago Substance Abuse: Substance Abuse Recent illicit drug use was more common among African American adults (8%) than among white adults (5.7%) in 1998 African American teenagers ages 12-17 years were less likely to use alcohol, marijuana or cocaine than white teenagers in 1999. In 2004 , New Yorkers living in poorer neighborhoods are 4x more likely to be hospitalized for drug use than those that live in wealthier neighborhoods. Mental Illness: Mental Illness Poorer New Yorkers are more than 2-6x more likely to experience serious emotional distress than those with higher incomes Rate of Mental Illness in Fordham and Bronx Park 13% Whereas, the rate of Mental Illness in wealthier Riverdale is 3% Homicide: Homicide For Brooklyn, the major urban community with the lowest homicide rates for young black males, roughly one in every 53 black 15-year-old males will die from homicide before reaching their 45th birthday. By contrast, the average 15-year-old U.S. male faces a very low one-in-185 probability of being murdered before reaching age 45. Most being Black on Black Violencemurdered before reaching age 45. Chance of being a murder victim White female 1:606 White male 1:106 Black female 1:124 Black male 1:29 Councilman James Davis WK Kellogg Foundation, CDC Prisons: Prisons Fastest growing business in the US Billions of tax dollars spent towards this Costs $35,000 yr to keep a prison in jail, this is enough money for an Ivy League Education More Black men in jail than in college In NYS the jail budget is higher than the state education budget Blacks make up 55% of the prison population and only 12% of the US population What are the Life Expectancy and Death Rates?: What are the Life Expectancy and Death Rates? Average life expectancy is 71.8 years for African Americans and 77.4 years for whites Black Men- 68.3 years White Men- 74.8 years Black Women- 75 years White Women- 80 years Between 1990 and 2001, black men’s life expectancy increased by nine years and black women increased by 5 years. Whites increased too by ½ as much Disparities in Educational Funding: Disparities in Educational Funding New York School districts serving poorer and minority neighborhoods receive $2152 less per student compared to school districts with fewer poor students An average elementary school may have 400 students translating into a massive $860,800 difference Pattern is not just in New York but across the country Lack of funding leads to lack of teachers, books, education…. The Funding Gap: Low- Income and Minority Students Receive Fewer Dollars by the Educational Trust 2002 Slide29: Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2003 Supplement. Disparities in Percentage Uninsured Among the Nonelderly Population by Race and Ethnic Origin, 2002 Slide30: Source: Employee Benefit Research Institute estimates from the March Current Population Survey, 2003 Supplement. Disparities in Percentage Uninsured Among Nonelderly Adults by Education, 2002 Access to Medical Care: Access to Medical Care Poorer New Yorkers without health coverage are the most likely to not receive medical care. However even those with private health insurance or Medicare, racial/ethnic and income disparities exist. “Race and income have substantial effects on mortality and use of services among Medicare beneficiaries. Medicare coverage alone is not sufficient to promote effective patterns of use by all beneficiaries “ Marian E. Gornick, M.S., Paul W. Eggers, Ph.D., Thomas W. Reilly, Ph.D., Renee M. Mentnech, M.S., Leslye K. Fitterman, Ph.D., Lawrence E. Kucken, M.P.A., and Bruce C. Vladeck, Ph.D. NEJM Vol 335:791-799, No. 11, 8/12/96 Slide32: If we change our minds we can change the times! Slide33: If we change our minds we can change the times! MUTUAL RESPECT: MUTUAL RESPECT We must all respect each other to prevent the atrocities of racism, discrimination How do we reduce disparities in health care?: How do we reduce disparities in health care? Reducing Disparities in Healthcare More minority health care providers are needed especially since they are more likely to serve in minority and medically underserved communities More interpreters to overcome language barriers Grassroots community based health workers to help patient navigate and access the health care system Provide understandable patient education programs and materials to increase patients knowledge of how to access care For pts whom cannot read, communicate effectively to our patients Educating health practitioners not to discriminate Bridging the Diversity Gap?: Bridging the Diversity Gap? % URMs in US Population % URM Matriculants 2025 URM Matriculants in 1995 1743 URM Matriculants in 1999 Percent YEAR Comparison of 2001 Acceptances With and Without Affirmative Action: Comparison of 2001 Acceptances With and Without Affirmative Action ESMA Health Pipeline Recruitment: ESMA Health Pipeline Recruitment *Local Affiliate Mentoring Program Clinical Society of Queens and Long Island High School and College Mentoring Program *Collaborate New Saturday Science Academy Program-(started at Drew University) Targeting Elementary School Students (www.nyesma.org) Mock Interview Program targeting medical students and residents *Student National Medical Association HPREP Maps Pipeline program (www.snma.org) Reducing Health Disparities: Reducing Health Disparities Increase physical activity Walking, running, athletics, swimming Health diet Increase water intake, vegetables, fruit, lean chicken and fish Avoid fats, red meats, starches, soda, juices Healthier behavior Avoid premarital/unprotected sex, smoking, drinking, substance abuse Must Stop & Prevent Tobacco Use: Must Stop & Prevent Tobacco Use Most preventable cause of death in our society accounting for 30% of all cancer deaths Causes nearly 87% of all lung cancers People who quit before the age of 50 cut their risk of dying in the next 15 years in half 80% of smokers begin to smoke before the age of 18 Economics: Economics Black people make up 14% of the US population We earn 600 billion dollars This would make us the 6th richest country on earth 98% of this money leaves the community within one exchange Other communities exchange the dollar 6-8x before leaving the community What did we spend our money on?: What did we spend our money on? 3.4 billion dollars on soda pop 500 million on coca cola alone We buy 50% of the grape soda in this country 23% of chewing gum We buy 25% of the movie tickets in the US 300 million on salty potato chips 6-8 billion on alcohol 30% of the country's Scotch Where do we need to spend our money?: Where do we need to spend our money? Education Home ownership Retirement savings Real estate investment Appreciating assets Healthy foods Cost conscious consuming HIGHER EDUCATION ALMOST ELIMINATES THE RACIAL UNEMPLOYMENT GAP: HIGHER EDUCATION ALMOST ELIMINATES THE RACIAL UNEMPLOYMENT GAP In June, 2004, the white unemployment rate was 5.1 percent. The rate for blacks was more than twice the white rate and stood at 10.7 percent. This two-to-one ratio has existed with little fluctuation for the past 50 years. Blacks armed with a four-year college diploma not only are far less likely to be unemployed, but the black-white unemployment gap is greatly reduced. In June 2004, 2.8 percent of whites with a four-year college degree were unemployed. For blacks the rate was 3.5 percent. Therefore, the historical two-to-one racial unemployment gap is reduced to 1.25-to-one for those with a college diploma. “US Labor Department, June 2004” NYC “Take Care New York”: NYC “Take Care New York” Have a regular doctor Be tobacco free Keep your heart healthy (control weight, Cholesterol, BP) Know your HIV status Get help for depression Live free of dependence on alcohol and drugs Get checked for cancer Get the immunizations you need Make your home safe and healthy from lead Have a healthy baby, obtain prenatal care NYC Department of Health and Mental Hygiene Empire State Medical Association: Empire State Medical Association Top 10 Health Policy Recommendations for New York Consider Eliminating HMO’s and decrease administrative cost of medicine (ie UNH, Dr McGuire 1.6 billion in stock options) Create legislation to allow independently practicing physicians to collectively negotiate contract terms with insurance companies Create and enhance preventive public service announcements, public health education protocols: Expand the healthcare safety net and create policy to increase access to health insurance for New Yorkers that do not have it. Parity in insurance coverage for mental illness. Repeal the New York Medicaid cuts for healthcare for those patients with dual Eligibility with Medicare and End Medicare fee cuts Tort reform with caps on malpractice awards. Reduce the Cost of Medications Regulate and investigate health insurance companies: Empire State Medical Association: Empire State Medical Association Create violence reduction, conflict resolution, and preventive law education protocols for junior high school students and public: Improve educational protocols in the zip codes with the highest health disparities: Immediately develop job training programs for men in NYC: Mandatory Cultural Competency Training. All of the above recommendations should be targeting the zip codes in New York that are clearly known to have these disparities in health, education, and unemployment. US Minority Zip Codes: US Minority Zip Codes Slide49: Areas most in need: Harlem, So. Bronx, Central Brooklyn Future : Future Resilience Perseverance and Will Education, Knowledge, Skills Religion, Righteousness Health, Diet, Exercise Healthy Behavior Economics, Investment, Ownership Political support Train the youth Economic Investment Get the word out! Will you be part of the problem or part of the solution?