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Slide 1
Lorraine Moya Salas, PhD Bianca Altamirano, MSW
Slide 2
Those challenged by poverty experience the poorest health.
Racial and ethnic minorities experience poorer health relative to
national averages from birth to death Higher infant mortality
Higher rates of disease and disability Shortened life
expectancy
Slide 3
Health inequalities are a result of both socioeconomic
advantage and race/ethnicity independently and in combination.
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One thing of course we must expect to find, and that is a much
higher death rate at present among Negroes than among whites. This
is one measure of the difference in their social advancement ~ W.
B. DuBois~
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Health status is a reflection of a myriad of factor including
personal choices, historic disadvantage and persistent social
inequalities.
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Conditions that foster disparities: Social determinants of
health are life-enhancing resources such as food supply, housing,
economic, and social relationships, transportation, education, and
health care whose distribution across populations effectively
determines length and quality of life.
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Upstream determinants change policies and environmental
conditions to promote health. Downstream determinants
interventions
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Behavioral health disorders are comparable across racial and
ethnic groups yet ethnic and racial groups are more adversely
impacted by their conditions.
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American Indians have a heightened risk for PTSD and alcohol
dependence. Higher rates of schizophrenia in the African American
community. Latino/African American youth have higher rates of PTSD.
Higher rates of psychological symptoms
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Social determinants influence the onset and progression of
health and mental health conditions. Environment plays a larger
role in the onset of conditions Progression of conditions are
impacted more so by access and quality of care.
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Physical health and mental health are interconnected. Emphasis
of interventions may differ but to achieve health a state of
complete physical, mental, and social well-being and not merely the
absence of disease we must attend to social determinants within and
outside health care systems.
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Resilience - successful adaptation despite threatening
circumstances, wellness in spite of significant risk.
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RISK FACTORSPROTECTIVE FACTORS Poverty Community
disorganization/violence Inadequate schools Trauma - racism Low
birth weight Genetic vulnerability Family conflict Maternal mental
disorder Dysfunctional childrearing environment Chronic health
conditions Hope/optimism Social competence Support family
relationships Parental structure/monitoring Caring schools
Availability of resources Social norms Sense of community
Spirituality/Religion Bicultural orientation
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Direct and Indirect Poor physical health Poor mental health
Substance Use
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Disease Environmental Conditions Downward Model
RacePovertyDepression Stress hormone dynamics (cell survival)
Neighborhood Conditions Tumor development
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Underutilization of services Socioeconomics (lack health
insurance, geographic factors) Provider bias Communication barriers
Lack of diversity among providers Distrust, stigma, alternative
health practices
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Comprehensive community interventions Community Health
Workers/Promotoras Integrated Care/Collaborative Care Models
Culturally tailored evidenced-based interventions
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Effective in changing environmental conditions that are linked
to chronic physical and mental health conditions Limited research
on effectiveness of specific community interventions. Best
available evidence
Lay members of communities who work either for pay or as
volunteers in association with the local health care system in both
urban and rural environments and usually share ethnicity, language,
socioeconomic status, and life experiences with the community they
serve.
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Improve health care access/utilization, increase health
knowledge, and the health status of people of color. Play a role in
changing community conditions.
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The systematic coordination of physical and behavioral health
services Co-location Coordination Engage consumers in the treatment
process Evidence-based guidelines
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Both empirically supported treatments and culturally adapted
interventions are effective. Preference findings, engagement, and
retention. Cultural considerations Historical trauma
Acculturation
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Whole-stream interventions Holistic health Evidence based
practice and culturally adapted/culturally supported
interventions